Background: Physician shortages and reimbursement changes have led to greater utilization of advanced practice providers (APP). National patterns of APP utilization for post-myocardial infarction (MI) patients are unknown.
Methods: We examined 29477 Medicare patients ≥65 years discharged alive after an MI at 364 US hospitals in the ACTION Registry-GWTG from 2007-2010. Using NPI data from Medicare claims, we determined whether a patient had an outpatient visit with an APP within 90 days after discharge. We compared characteristics of patients seen by an APP vs. a physician only, stratified by % hospital APP use.
Results: Within 90 days of discharge, 11% of MI patients were seen by an APP. Patients seen by APPs were more likely to be female (49% vs. 45%), have diabetes (37% vs. 33%) or heart failure (20% vs. 16%), and discharged to a nursing facility (21% vs. 13%, p<0.01 for all) than patients seen by a physician only. The number of outpatient visits within 90 days of discharge was higher for APP patients (median 6 vs. 5, p<0.01). Among hospitals, the median % of patients discharged to APP follow-up was 9.1%. APP follow-up was used more by non-teaching than teaching hospitals (29% vs. 25%, p<0.01). Whether higher risk patients are referred to APP care did not differ much among hospitals that more or less frequently used an APP post-discharge (Figure).
Conclusions: Current US practice reveals APPs are utilized to provide closer follow-up to more complex MI patients after discharge. APP referral patterns do not substantially vary by how frequently a hospital utilizes APPs.