Scope-of-practice regulations may affect the propensity of providers to form care teams. For this reason, it's critical that policymakers understand differences in outcomes for team-based versus solo care as well as by solo care provider type and team composition. Researchers examined how outcomes of new-onset chronic disease differed by team-based versus solo care and by physician versus nonphysician (that is, NP or physician assistant) care in a national sample of primary care practices from 2013 to 2018.
They analyzed deidentified electronic health record (EHR) data from a large national EHR vendor that included detailed primary care visit information. The researchers identified patients who had new-onset type 2 diabetes, hyperlipidemia, or hypertension using biomarker evidence. The sample included 2,028 primary care providers from 250 practices.
Provider teams submitted diagnostic claims at significantly higher rates than solo providers for type 2 diabetes and hypertension but at similar rates for hyperlipidemia. Prescription ordering by teams versus solo providers differed for all three diseases. Teams were more likely to order at least one follow-up biomarker test for patients with type 2 diabetes and hyperlipidemia. For all three diseases, patients treated by teams were more likely to achieve disease control.
Physician and mixed teams performed better than nonphysician teams in the management of hypertension, but otherwise there were no significant differences by team composition. For all three diseases, the performance of solo physicians and nonphysicians was similar, but physicians were less likely to prescribe drugs for type 2 diabetes and hyperlipidemia. Interventions that promote the formation of provider teams may improve the value of care, the authors conclude.
The study had several limitations. Unmeasured confounders may have affected the results, interactions between providers weren't observed, the study's definition of team-based care was narrow, and disease control may have been overestimated.