Process and outcome measures among COPD patients with a hospitalization cared for by an advance practice provider or primary care physician

Amitesh Agarwal, Wei Zhang, Yong Fang Kuo, Gulshan Sharma

Research output: Contribution to journalArticle

7 Scopus citations


Objectives: To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians. Methods: We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010. Results: A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95% Confidence Interval [CI] 1.05-1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12-1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23-1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71-0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI1.07-1.48) than those cared for by physicians.

Original languageEnglish (US)
Article numbere0148522
JournalPLoS One
Issue number2
StatePublished - Feb 1 2016


ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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