The Scope of Care Coordination for Older Adults Whose Dominant Provider Is a Nurse Practitioner Versus a Primary Care Physician

Background: Nurse practitioners (NPs) play an increasingly prominent role in primary care, particularly in low-income and rural communities. Yet the differences in care coordination demands between NP-dominant and physician-dominant primary care remain unknown. An increased need for care coordination increases the likelihood of communication breakdowns. Objective: To determine if the scope of care coordination (ie, the number of other providers involved in a patient’s care) varies by NP versus generalist physician. Methods: In 2425 participants from the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study linked with 2013–2016 Medicare claims, we conducted a cross-sectional study using negative binomial regression analyses. Results: Our sample was 52.1% female with a mean age of 75.6 years. Participants with dominant NPs (n=146, 6%) were more likely to be dually eligible for Medicaid and reside in rural areas, but had fewer chronic conditions than those with dominant generalist physicians (n=2279, 94%). The median number of other unique providers involved in care was 4 (IQR=2–6) for NP-dominant patients versus 3 (IQR=2–6) for physician-dominant patients. After adjusting for covariates, those with dominant NPs had 19% more unique providers involved in their care (IRR=1.19, 95% CI: 1.07–1.32). Among participants with 5+ chronic conditions, participants with dominant NPs were seen by 31% more unique providers per year (IRR=1.31, 95% CI: 1.12–1.54). Conclusion: Older adults receiving NP-dominant primary care had a broader scope of care coordination than those receiving generalist physician-dominant primary care, especially among those with 5+ chronic conditions.