Funkhouser E (Birmingham REAP), Johnson-Roe NK
(Birmingham REAP), Levine DA
(Ohio State University), Houston TK
We sought to evaluate whether CBOC performance differed according to CBOC provider composition using baseline data from the VA MI-plus comorbidities randomized trial of Internet-delivered health professional education.
We used electronic algorithms to extract baseline data from the CPRS electronic health record to measure 11 performance indicators for ambulatory post-MI patients treated at one of 211 CBOCs located across the US: use of aspirin, beta-blockers, and lipid-lowering medications; use of ACEI-ARBS for patients with CHF or diabetes (if hypertension or chronic kidney disease (CKD)); smoking status screening and cessation counseling; and obtaining lipid profile and A1C (for diabetics). CBOC provider composition, defined as proportion of physicians (MDs) and allied health professionals (physician assistants and nurse practitioners), was obtained by calling each CBOC and verifying active clinical staff. Adjusting for number of providers per CBOC, rank correlations of proportion of CBOC providers that were MDs were estimated for each performance measure among the 211 CBOCs. Mean performance measures, adjusted for number of providers and geographic region, were then estimated for 4-categories of CBOCs (no MDs [n = 13], < = 50% MDs [n = 52], 51-99% MDs [n = 74], and only MDs [n = 72]).
The median number of providers per CBOC was 3 (range: 1 to 44), and the median percent of MD CBOC providers was 71.4% (range: 0 to 100). The proportion of MD CBOC providers varied by US region, with higher proportions in the South. There was no correlation (r = -0.06) between number of CBOC providers and proportion of MDs. Adjusting for number of providers, only 2 of the 11 performance measures were positively correlated with higher proportion of MDs (lipid profile, r = 0.27; A1C, r = 0.21). Mean performance measures, adjusted for region and number of providers, differed for the four categories (no MDs to all MDs) for only two measures (lipid profile and ACEI-ARBS for diabetics with CKD), and these performance differences were in opposite directions.
There is very little variation in post-MI performance measures according to composition of CBOC providers.
Allied health professionals play a vital role in the treatment of veterans, including the care of complex post-MI patients with multiple comorbidities.