Electronic health record data linked with Medicare data from an academic physician group were used to propose a multidimensional characterization of PA and NP roles on panels of primary care patients with diabetes. Seven PA and NP roles were defined based on level of involvement, visits with complex patients, and delivery of chronic care. Findings suggest that PAs and NPs in primary care perform a variety of roles and frequently perform multiple roles within a clinic.
Christine M. Everett is an assistant professor in the PA program at Duke University School of Medicine in Durham, N.C. Carolyn T. Thorpe is an assistant professor in Health Services Research and Development at the Veterans Affairs Pittsburgh Healthcare System and in the Department of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy in Pittsburgh, Pa. Mari Palta is a professor in the Department of Population Health Sciences at the University of Wisconsin-Madison. Pascale Carayon is a professor in the Center for Quality and Productivity Improvement in the Department of Industrial and Systems Engineering at the University of Wisconsin-Madison. Valerie J. Gilchrist is a professor and department chair of the Department of Family Medicine at the University of Wisconsin-Madison. Maureen A. Smith is a professor in the departments of population health sciences, family medicine, and surgery at the University of Wisconsin-Madison. The authors disclose that funding for this project was provided by the Agency for Healthcare Research and Quality, grant numbers R21 HS017646 and R01 HS018368. Additional support was provided by the Health Innovation Program, which assisted with institutional review board application, Medicare data management, variable creation, and manuscript formatting; the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health; and the UW School of Medicine and Public Health from the Wisconsin Partnership Program. One author was supported by the AHRQ/National Research Service Award T-32 Institutional Training Program Grant Number: 5-T32-HS00083 and the American Academy of Physician Assistants' Breitman-Dorn Fellowship. No other funding source had a role in the design or conduct; data collection, management, analysis or interpretation; or preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
Acknowledgments: The authors would like to thank Katie Ronk, Colleen Brown, and Rebecca Gittelson for their help with this manuscript.