Table 1 Characteristics of VA Patients with Diabetes by Continuity of Care in Primary Care Providera Type Assigned
Category | Switched Providers n = 146,500 | Same Provider n = 509,868 | Total n = 656,368 |
|---|---|---|---|
Patient-level factors | |||
Male | 140,638 (96.0) | 492,869 (96.7) | 633,507 (96.5) |
Female | 5862 (4.0) | 16,999 (3.3) | 22,861 (3.5) |
Age Group | |||
Less Than 40 | 2052 (1.40) | 4862 (0.95) | 6914 (1.05) |
40 to Less Than 65 | 80,264 (54.8) | 261,109 (51.2) | 341,373 (52.0) |
65 to Less Than 80 | 52,682 (36.0) | 196,840 (38.6) | 249,522 (38.0) |
80 and Over | 11,502 (7.85) | 47,057 (9.23) | 58,559 (8.92) |
Race | |||
White | 103,597 (70.7) | 363,036 (71.2) | 466,633 (71.1) |
American Indian | 1289 (0.88) | 3678 (0.72) | 4967 (0.76) |
Asian | 918 (0.63) | 2832 (0.56) | 3750 (0.57) |
Black | 26,975 (18.4) | 91,991 (18.0) | 118,966 (18.1) |
Native Hawaiian | 1599 (1.09) | 5596 (1.10) | 7195 (1.10) |
Unknown or Missing | 12,122 (8.27) | 42,735 (8.38) | 54,857 (8.36) |
Hispanic | 8561 (5.84) | 24,157 (4.74) | 32,718 (4.98) |
Marital Status | |||
Currently Married | 84,329 (57.6) | 308,274 (60.5) | 392,603 (59.8) |
Never Married | 17,016 (11.6) | 54,421 (10.7) | 71,437 (10.9) |
Previously Married | 44,772 (30.6) | 145,689 (28.6) | 190,461 (29.0) |
Unknown Marital Status | 383 (0.26) | 1484 (0.29) | 1867 (0.28) |
Homeless at Any Time During Year | 4549 (3.11) | 8711 (1.71) | 13,260 (2.02) |
Copay Status | |||
No Copay Due to Disability | 81,123 (55.4) | 278,359 (54.6) | 359,482 (54.8) |
No Copay Due to Low Income | 40,864 (27.9) | 133,272 (26.1) | 174,136 (26.5) |
Must Pay Copay | 22,502 (15.4) | 91,157 (17.9) | 113,659 (17.3) |
Copay Status Unknown | 2011 (1.37) | 7080 (1.39) | 9091 (1.39) |
Mental Health Diagnoses | |||
Mood Disorder | 39,135 (26.7) | 121,321 (23.8) | 160,456 (24.4) |
Post-Traumatic Stress Disorder | 22,683 (15.5) | 72,896 (14.3) | 95,579 (14.6) |
Dementia | 4957 (3.38) | 15,236 (2.99) | 20,193 (3.08) |
Substance Abuse | 13,689 (9.34) | 38,160 (7.48) | 51,849 (7.90) |
Other Mental Health Diagnosis | 8782 (5.99) | 30,004 (5.88) | 38,786 (5.91) |
Diagnostic Cost Group (DCG) Score Category | |||
Less Than or Equal to 0.5 | 69,654 (47.5) | 260,010 (51.0) | 329,664 (50.2) |
Greater Than 0.5 to 1 | 25,123 (17.1) | 86,700 (17.0) | 111,823 (17.0) |
Greater Than 1 to 1.5 | 19,313 (13.2) | 64,932 (12.7) | 84,245 (12.8) |
Greater Than 1.5 to 2 | 11,228 (7.66) | 35,519 (6.97) | 46,747 (7.12) |
Greater Than 2 | 21,182 (14.5) | 62,707 (12.3) | 83,889 (12.8) |
Distance from VHA Primary Care Clinic | |||
Less Than 5 Miles | 31,941 (21.8) | 119,774 (23.5) | 151,715 (23.1) |
5 to Less Than 25 Miles | 71,412 (48.7) | 265,553 (52.1) | 336,965 (51.3) |
25 to Less Than 50 Miles | 24,976 (17.0) | 83,394 (16.4) | 108,370 (16.5) |
50 Miles and Over | 17,018 (11.6) | 37,448 (7.34) | 54,466 (8.30) |
Missing | 1153 (0.79) | 3699 (0.73) | 4852 (0.74) |
Baseline BMI | |||
Less Than 18.5 | 363 (0.25) | 1152 (0.23) | 1515 (0.23) |
18.5 to Less Than 25 | 13,566 (9.26) | 47,100 (9.24) | 60,666 (9.24) |
25 to Less Than 30 | 42,293 (28.9) | 149,814 (29.4) | 192,107 (29.3) |
30 to Less Than 35 | 46,015 (31.4) | 160,415 (31.5) | 206,430 (31.5) |
35 and Above | 44,263 (30.2) | 151,387 (29.7) | 195,650 (29.8) |
Number of PC Visits | |||
1 PC Visit | 39,830 (27.2) | 103,854 (20.4) | 143,684 (21.9) |
2 PC Visits | 38,382 (26.2) | 192,864 (37.8) | 231,246 (35.2) |
3 PC Visits | 32,305 (22.1) | 104,846 (20.6) | 137,151 (20.9) |
4 or More PC Visits | 35,983 (24.6) | 108,304 (21.2) | 144,287 (22.0) |
Pharmacy Fill of Insulin | 65,784 (44.9) | 216,765 (42.5) | 282,549 (43.0) |
Patient Had Same Zip Code in FY12 and FY13 | 127,158 (86.8) | 478,420 (93.8) | 605,578 (92.3) |
Provider-level factors | |||
Assigned Provider Type in FY12 | |||
Physician | 104,395 (71.3) | 394,959 (77.5) | 499,354 (76.1) |
Nurse Practitioner | 25,616 (17.5) | 79,588 (15.6) | 105,204 (16.0) |
Physician Assistant | 10,185 (6.95) | 30,798 (6.04) | 40,983 (6.24) |
Physician Resident | 6304 (4.30) | 4523 (0.89) | 10,827 (1.65) |
Assigned Provider Type in FY13 | |||
Physician | 87,706 (59.9) | 395,286 (77.5) | 482,992 (73.6) |
Nurse Practitioner | 20,564 (14.0) | 79,464 (15.6) | 100,028 (15.2) |
Physician Assistant | 7178 (4.90) | 30,716 (6.02) | 37,894 (5.77) |
Physician Resident | 5051 (3.45) | 4402 (0.86) | 9453 (1.44) |
Unable to Assign | 26,001 (17.7) | 26,001 (3.96) | |
Provider Turnover from Station | 24,512 (16.7) | 8746 (1.72) | 33,258 (5.07) |
Facility-level factors | |||
Endocrinology Referral Capacityb | 70,437 (48.1) | 238,805 (46.8) | 309,242 (47.1) |
Rural Urban Commuting Area Status | |||
Metropolitan Area Core | 106,700 (72.8) | 377,339 (74.0) | 484,039 (73.7) |
Metropolitan Area Core - Remaining Levels | 16,423 (11.2) | 62,616 (12.3) | 79,039 (12.0) |
Micropolitan Area Core | 18,003 (12.3) | 53,501 (10.5) | 71,504 (10.9) |
Small Town or Rural | 5374 (3.67) | 16,412 (3.22) | 21,786 (3.32) |
State-level factors | |||
Percent of Primary Care Physicians Who Work With NPs/PAs | |||
Lowest Tertile | 78,653 (53.7) | 284,992 (55.9) | 363,645 (55.4) |
Middle Tertile | 38,373 (26.2) | 133,094 (26.1) | 171,467 (26.1) |
Highest Tertile | 29,474 (20.1) | 91,782 (18.0) | 121,256 (18.5) |
Nurse Practitioner Scope of Practice Regulations | |||
Least Restrictive | 23,738 (16.2) | 69,747 (13.7) | 93,485 (14.2) |
Moderately Restrictive | 22,697 (15.5) | 79,056 (15.5) | 101,753 (15.5) |
Most Restrictive | 100,065 (68.3) | 361,065 (70.8) | 461,130 (70.3) |
Physician Assistant Scope of Practice Regulations | |||
Least Restrictive | 20,774 (14.2) | 69,521 (13.6) | 90,295 (13.8) |
Moderately Restrictive | 36,532 (24.9) | 113,202 (22.2) | 149,734 (22.8) |
Most Restrictive | 89,194 (60.9) | 327,145 (64.2) | 416,339 (63.4) |
VISN-LEVEL factors | |||
Region | |||
Northeast | 16,522 (11.3) | 75,920 (14.9) | 92,442 (14.1) |
West | 32,865 (22.4) | 91,014 (17.9) | 123,879 (18.9) |
Midwest | 31,983 (21.8) | 116,774 (22.9) | 148,757 (22.7) |
South | 65,130 (44.5) | 226,160 (44.4) | 291,290 (44.4) |