ArticlePloS one2020
Processes and outcomes of diabetes mellitus care by different types of team primary care models.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 13 citations in OpenAlex.
- A Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations.Health systems and reform · 2025Article
- Contributions of Specialized Nurses to Medication Management for Older People in Home Care: A Mixed-Method Systematic Review.Risk management and healthcare policy · 2025Review
- Experience of humanistic nursing in hemodialysis nursing for patients with diabetic kidney disease.World journal of diabetes · 2024Article
- Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels.Mayo Clinic proceedings. Innovations, quality & outcomes · 2023Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
backgroundTeam care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs).
methodsWe studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition.
resultsCompared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00-1.08), 1.08 (95% CI: 1.03-1.13), and 1.10 (95% CI: 1.05-1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04-1.18), 1.11 (95% CI: 1.02-1.20), and 1.15 (95% CI: 1.06-1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00-1.07), and 1.06 (95% CI: 1.02-1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices.
conclusionThe team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.
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