Table 1:
Characteristics of VA Patients with Diabetes by Primary Care Provider1 Type Assigned In Cost and Utilization Sample
| Category | Nurse Practitioner n=67,120 | Physician Assistant n=25,352 | Physician n=276,009 | Total n=368,481 |
|---|---|---|---|---|
| PATIENT-LEVEL FACTORS | ||||
| Male N (%) | 63739 ( 95.0) | 24636 ( 97.2) | 267828 ( 97.0) | 356203 ( 96.7) |
| Age Mean (SD) | 65.2(10.2) | 65.5(10.1) | 65.2(10.0) | 65.2(10.0) |
| Age Group N (%) | ||||
| Less Than 40 | 718 ( 1.1) | 256 ( 1.0) | 2486 ( 0.9) | 3460 ( 0.9) |
| 40 to Less Than 65 | 34108 ( 50.8) | 12628 ( 49.8) | 141839 ( 51.4) | 188575 ( 51.2) |
| 65 to Less Than 80 | 25867 ( 38.5) | 9989 ( 39.4) | 106050 ( 38.4) | 141906 ( 38.5) |
| 80 and Over | 6427 ( 9.6) | 2479 ( 9.8) | 25634 ( 9.3) | 34540 ( 9.4) |
| Race N (%) | ||||
| White | 48530 ( 72.3) | 18939 ( 74.7) | 192958 ( 69.9) | 260427 ( 70.7) |
| Black | 11673 ( 17.4) | 3934 ( 15.5) | 53694 ( 19.5) | 69301 ( 18.8) |
| Native Hawaiian | 605 ( 0.9) | 228 ( 0.9) | 3184 ( 1.2) | 4017 ( 1.1) |
| American Indian | 472 ( 0.7) | 193 ( 0.8) | 1927 ( 0.7) | 2592 ( 0.7) |
| Asian | 290 ( 0.4) | 77 ( 0.3) | 1552 ( 0.6) | 1919 ( 0.5) |
| Unknown or Missing | 5550 ( 8.3) | 1981 ( 7.8) | 22694 ( 8.2) | 30225 ( 8.2) |
| Hispanic N (%) | 2556 ( 3.8) | 913 ( 3.6) | 13247 ( 4.8) | 16716 ( 4.5) |
| Marital Status N (%) | ||||
| Currently Married | 39781 ( 59.3) | 15630 ( 61.7) | 164741 ( 59.7) | 220152 ( 59.7) |
| Previously Married | 19468 ( 29.0) | 7173 ( 28.3) | 79935 ( 29.0) | 106576 ( 28.9) |
| Never Married | 7651 ( 11.4) | 2493 ( 9.8) | 30540 ( 11.1) | 40684 ( 11.0) |
| Unknown Marital Status | 220 ( 0.3) | 56 ( 0.2) | 793 ( 0.3) | 1069 ( 0.3) |
| Homeless at Any Time During Year N (%) | 1248 ( 1.9) | 365 ( 1.4) | 5065 ( 1.8) | 6678 ( 1.8) |
| Copay Status N (%) | ||||
| No Copay Due to Disability | 35091 ( 52.3) | 13341 ( 52.6) | 152246 ( 55.2) | 200678 ( 54.5) |
| No Copay Due to Low Income | 17847 ( 26.6) | 6568 ( 25.9) | 72570 ( 26.3) | 96985 ( 26.3) |
| Must Pay Copay | 13031 ( 19.4) | 5105 ( 20.1) | 47447 ( 17.2) | 65583 ( 17.8) |
| Copay Status Unknown | 1151 ( 1.7) | 338 ( 1.3) | 3746 ( 1.4) | 5235 ( 1.4) |
| Mental Health Diagnoses N (%) | ||||
| Mood Disorder | 2857 ( 4.3) | 1013 ( 4.0) | 12715 ( 4.6) | 16585 ( 4.5) |
| Post-Traumatic Stress Disorder | 9365 ( 14.0) | 3410 ( 13.5) | 39732 ( 14.4) | 52507 ( 14.2) |
| Dementia | 1826 ( 2.7) | 736 ( 2.9) | 8712 ( 3.2) | 11274 ( 3.1) |
| Substance Abuse | 5268 ( 7.8) | 1656 ( 6.5) | 21453 ( 7.8) | 28377 ( 7.7) |
| Other Mental Health Diagnosis | 10917 ( 16.3) | 3903 ( 15.4) | 44696 ( 16.2) | 59516 ( 16.2) |
| DCG Risk Score Mean (SD) | 0.9(1.2) | 0.9(1.2) | 1.0(1.4) | 1.0(1.3) |
| Diagnostic Cost Group (DCG) Score Category N (%) | ||||
| Less Than or Equal to 0.5 | 34768 ( 51.8) | 13464 ( 53.1) | 136895 ( 49.6) | 185127 ( 50.2) |
| Greater Than 0.5 to 1 | 11693 ( 17.4) | 4143 ( 16.3) | 46508 ( 16.9) | 62344 ( 16.9) |
| Greater Than 1 to 1.5 | 8648 ( 12.9) | 3205 ( 12.6) | 35701 ( 12.9) | 47554 ( 12.9) |
| Greater Than 1.5 to 2 | 4431 ( 6.6) | 1725 ( 6.8) | 20064 ( 7.3) | 26220 ( 7.1) |
| Greater Than 2 | 7580 ( 11.3) | 2815 ( 11.1) | 36841 ( 13.3) | 47236 ( 12.8) |
| Distance to Assigned Facility Mean (SD) | 19.2(35.1) | 21.2(39.0) | 20.3(39.1) | 20.2(38.4) |
| Distance from VHA Primary Care Clinic N (%) | ||||
| Less Than 5 Miles | 17008 ( 25.3) | 6049 ( 23.9) | 62535 ( 22.7) | 85592 ( 23.2) |
| 5 to Less Than 25 Miles | 33650 ( 50.1) | 12320 ( 48.6) | 143986 ( 52.2) | 189956 ( 51.6) |
| 25 to Less Than 50 Miles | 10873 ( 16.2) | 4752 ( 18.7) | 45931 ( 16.6) | 61556 ( 16.7) |
| 50 Miles and Over | 4830 ( 7.2) | 2088 ( 8.2) | 21752 ( 7.9) | 28670 ( 7.8) |
| Missing | 759 ( 1.1) | 143 ( 0.6) | 1805 ( 0.7) | 2707 ( 0.7) |
| Body Mass Index (BMI) Category N (%) | ||||
| 13 to Less Than 18.5 | 126 ( 0.2) | 43 ( 0.2) | 653 ( 0.2) | 822 ( 0.2) |
| 18.5 to Less Than 25 | 6020 ( 9.0) | 2202 ( 8.7) | 25742 ( 9.3) | 33964 ( 9.2) |
| 25 to Less Than 30 | 19517 ( 29.1) | 7406 ( 29.2) | 80879 ( 29.3) | 107802 ( 29.3) |
| 30 to Less Than 35 | 21329 ( 31.8) | 8124 ( 32.0) | 86356 ( 31.3) | 115809 ( 31.4) |
| 35 to Less Than 40 | 12085 ( 18.0) | 4535 ( 17.9) | 49845 ( 18.1) | 66465 ( 18.0) |
| 40 to 85 | 8043 ( 12.0) | 3042 ( 12.0) | 32534 ( 11.8) | 43619 ( 11.8) |
| Baseline Body Mass Index (BMI) Mean (SD) | 32.5(6.4) | 32.5(6.4) | 32.4(6.5) | 32.5(6.5) |
| Baseline HgBA1C Mean (SD) | 7.6(1.5) | 7.6(1.4) | 7.6(1.5) | 7.6(1.5) |
| Baseline Systolic Blood Pressure Mean (SD) | 132.9(13.0) | 132.8(12.9) | 133.1(13.2) | 133.1(13.2) |
| Baseline LDL Cholesterol Mean (SD) | 87.2(29.9) | 87.0(29.7) | 85.8(29.6) | 86.1(29.6) |
| % Visits PCP Seen Mean (SD) | 77.0(25.1) | 77.9(24.7) | 75.3(25.8) | 75.8(25.6) |
| More Than 1 Visit with Assigned PCP N (%) | 54220 ( 80.8) | 20791 ( 82.0) | 215247 ( 78.0) | 290258 ( 78.8) |
| 3 or More Chronic Conditions N (%) | 56089 ( 83.6) | 20996 ( 82.8) | 232168 ( 84.1) | 309253 ( 83.9) |
| FACILITY-LEVEL FACTORS | ||||
| Endocrinology Referral Capacity2 N (%) | 27788 ( 41.4) | 11110 ( 43.8) | 152237 ( 55.2) | 191135 ( 51.9) |
| Rural Urban Commuting Area Status N (%) | ||||
| Metropolitan Area Core | 50114 ( 74.7) | 17040 ( 67.2) | 214034 ( 77.5) | 281188 ( 76.3) |
| Metropolitan Area Core - Remaining Levels | 5692 ( 8.5) | 4158 ( 16.4) | 33704 ( 12.2) | 43554 ( 11.8) |
| Micropolitan Area Core | 8232 ( 12.3) | 3332 ( 13.1) | 21494 ( 7.8) | 33058 ( 9.0) |
| Small Town or Rural | 3082 ( 4.6) | 822 ( 3.2) | 6777 ( 2.5) | 10681 ( 2.9) |
| STATE-LEVEL FACTORS | ||||
| Region N (%) | ||||
| South | 19260 ( 28.7) | 9631 ( 38.0) | 122345 ( 44.3) | 151236 ( 41.0) |
| Midwest | 18805 ( 28.0) | 6792 ( 26.8) | 65784 ( 23.8) | 91381 ( 24.8) |
| Northeast | 14814 ( 22.1) | 5810 ( 22.9) | 40896 ( 14.8) | 61520 ( 16.7) |
| West | 14241 ( 21.2) | 3119 ( 12.3) | 46984 ( 17.0) | 64344 ( 17.5) |
Data for patient-level variables are from the Veterans Administration electronic health record files. Other data sources are described in the Methods section.
1
Primary care provider (PCP) is assigned as the physician, NP, or PA seen most during FY 2012 and 2013.
2
Endocrinology referral capacity is defined as either present (endocrinology or other diabetes mellitus specialty clinics provided 500 or more visits to cohort patients in FY12) or absent (fewer than 500 visits to cohort patients).