Comparing primary care providers in community health centers

Under the Affordable Care Act, the number and capacity of community health centers (CHCs) is growing. Although most healthcare in CHCs is provided by primary care physicians, a growing proportion is delivered by NPs and PAs; yet, little is known about how these clinicians' care compares in this setting. To compare the quality of care and practice patterns of NPs, PAs, and physicians in CHCs, the authors used 5 years of data (2006-2010) from the CHC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis. They estimated the effect of receiving NP-delivered or PA-delivered care versus primary care physician-delivered care. The authors used design-based and model-based inference and weighted all estimates. Primary analyses of 23,704 patient visits to 1,139 practitioners resulted in a sample representing about 30 million patient visits to CHCs in the United States. Also examined were nine patient-level outcomes: three quality indicators, four service use measures, and two referral pattern measures. On seven of the nine outcomes studied, no statistically significant differences were detected in NP or PA care compared with physician care. Of the remaining outcomes, patients who saw NPs were more likely to receive recommended smoking cessation counseling and more health education and counseling services than patients who saw physicians. Patients who saw PAs also received more health education and counseling services than those who saw physicians.(1)