Key result
Nurse practitioners ordered low-value back images significantly less often than physician assistants (25.5% vs. 39.2%, adjusted difference of 10.0 percentage points; p < 0.0001).
Why the study?
Little is known about practice pattern differences between nurse practitioners and physician assistants.
Do nurse practitioners order fewer low-value back images compared to physician assistants in Medicare beneficiaries?
Observational (n=438)
Yes
Do nurse practitioners order fewer low-value back images compared to physician assistants in Medicare beneficiaries?
Absolute Risk Reduction: 10
Absolute Event Rate: 25.5% vs 39.2%
Absolute Risk Reduction: 10%
p-value: p=<.0001
Nurse practitioners order significantly fewer low-value back images than physician assistants for Medicare beneficiaries, likely reflecting different practice settings.
May inform advanced practice provider staffing to curb low-value imaging; leaves open causal mechanisms and broader applicability.
Little is known about practice pattern differences between nurse practitioners (NPs) and physician assistants (PAs). We compared the rates of low-value back images ordered by NPs and PAs. For this comparison, we used 2012-2013 Medicare Part B claims for all beneficiaries in 18 hospital referral regions and a measure of low-value back imaging from the Choosing Wisely recommendations. Models included a random clinician effect and fixed effects for beneficiary age, disability, Elixhauser comorbidities, clinician type, the emergency department setting, and region. NPs ( N = 234) order low-value back images significantly less than PAs ( N = 204) (NPs 25.5% vs. PAs 39.2%, p < .0001). Controlling for relevant factors, NPs are 10.0 percentage points ( p < .0001) less likely to order a low-value back image than PAs. NPs and PAs have distinct patterns of low-value back imaging, which is likely a reflection of their different practice settings.
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O’Reilly-Jacob et al. (2019) conducted an observational in Low-value back imaging (n=438). Care by Nurse Practitioners vs. Care by Physician Assistants was evaluated on Rates of low-value back images ordered (10.0 percentage points difference, p=<.0001). Nurse practitioners ordered low-value back images significantly less often than physician assistants (25.5% vs. 39.2%, adjusted difference of 10.0 percentage points; p < 0.0001).
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