ONLINE APPENDIX
Supplemental Table 1: Comparison of compliance with coronary artery disease, heart failure
and atrial fibrillation measures among patients receiving care from advanced practice providers
and physician providers in states with independent scope of practice laws for nurse practitioners
Provider category
Advanced practice Physician providers
providers
n = 21
n = 97
(7806 patients)
(60425 patients)
Beta-blocker use in CAD
80.3 ± 12.9
79.9 ± 10.0
patients with prior MI
Antiplatelet use in CAD
83.3 ± 11.0
82.7 ± 10.0
patients
Smoking cessation
43.3 ± 35.9
54.1 ± 33.4
(screening and intervention)
Rate ratio*
(unadjusted)
[Physician
providers as
referent
category]
1.02 (0.95-
Rate ratio
(adjusted)†
[Physician
providers as
referent
category]
1.01 (0.97-
1.10)
1.06)
1.01 (0.95-
1.06 (0.98-
1.07)
1.13)
0.82 (0.54-
1.19 (0.87-
1.24)
1.63)
0.80 (0.39-
1.72 (1.35-
1.62)
2.20)
2.58 (0.49-
1.12 (0.76-
13.47)
1.66)
1.00 (0.94-
0.98 (0.92-
1.06)
1.05)
1.00 (0.95-
1.02 (0.99-
1.06)
1.05)
in CAD patients
Cardiac rehabilitation referral 9.0 ± 21.2
9.2 ± 12.4
in CAD patients
Symptom and activity
51.2 ± 47.8
32.4 ± 41.6
assessment in CAD patients
ACE-I/ARB in CAD patients 68.7 ± 9.7
69.8 ± 11.3
with LV EF<40%
Lipid-lowering in CAD
patients
80.7 ± 11.6
80.7 ± 8.4
Provider category
Advanced practice Physician providers
providers
n = 21
n = 97
(7806 patients)
(60425 patients)
Blood pressure assessment
98.4 ± 3.0
98.8 ± 2.2
in CAD patients
All above CAD performance 25.3 ± 24.0
14.9 ± 20.0
measures met in eligible
Rate ratio*
(unadjusted)
[Physician
providers as
referent
category]
1.00 (1.00-
Rate ratio
(adjusted)†
[Physician
providers as
referent
category]
1.00 (0.99-
1.01)
1.02)
2.75 (0.62-
1.05 (0.76-
12.27)
1.45)
0.98 (0.91-
1.01 (0.94-
1.06)
1.09)
1.02 (0.99-
1.00 (0.96-
1.04)
1.04)
0.98 (0.89-
1.02 (0.93-
1.09)
1.12)
1.00 (0.92-
1.00 (0.96-
1.09)
1.05)
patients
ACE-I/ARB use in patients
78.7 ± 16.1
78.3 ± 16.0
with LVEF<40%
Beta-blocker use in patients
96.7 ± 5.2
94.7 ± 5.6
with LVEF<40%
Both HF measures performan 77.2 ± 16.5
75.8 ± 17.3
ce measures met
Anticoagulant use
in AF patients with CHADS2
63.6 ± 12.6
65.4 ± 12.0
score >2
*rate ratio = rate for compliance with a performance measure among advanced practice providers
/rate of compliance with a performance measure among physician providers
†adjusted for practice, provider gender, number of patients in provider panel in 2012, length of
PINNACLE registry participation, number of outpatient visits, patient’s age, gender, insurance,
history of diabetes, hypertension, myocardial infarction, and PCI or CABG in the last 12 months
CAD, coronary artery disease; MI, myocardial infarction; LVEF, left ventricular ejection
fraction; ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker
ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; HF, heart
failure; AF, atrial fibrillation; CHADs2 score for stroke risk assessment in atrial fibrillation
(congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke); PCI,
percutaneous coronary intervention; CABG, coronary artery bypass grafting
Supplemental Table 2: Comparison of compliance with coronary artery disease, heart failure
and atrial fibrillation measures among patients receiving care from advanced practice providers
and physician providers in states without independent scope of practice laws for nurse
practitioners
Provider category
Advanced practice Physician providers
providers
n = 146
n = 539
(35725 patients)
(355713 patients)
Beta-blocker use in CAD
81.7 ± 15.4
78.6 ± 13.4
patients with prior MI
Antiplatelet use in CAD
80.8 ± 12.5
79.3 ± 13.1
patients
Smoking cessation
46.0 ± 39.7
41.2 ± 36.6
(screening and intervention)
Rate ratio*
(unadjusted)
[Physician
providers as
referent
category]
1.12 (1.09-
Rate ratio
(adjusted)†
[Physician
providers as
referent
category]
1.01 (0.93-
1.15)
1.10)
1.04 (1.01-
1.03 (0.99-
1.07)
1.08)
1.08 (0.88-
1.15 (1.03-
1.33)
1.27)
2.27 (1.70-
1.33 (1.07-
3.02)
1.67)
1.47 (0.84-
1.00 (0.77-
2.55)
1.29)
1.07 (1.04-
1.01 (0.96-
1.11)
1.06)
1.04 (1.01-
1.01 (0.97-
1.06)
1.06)
in CAD patients
Cardiac rehabilitation referral 12.2 ± 13.8
6.9 ± 10.2
in CAD patients
Symptom and activity
28.5 ± 38.4
29.1 ± 37.5
assessment in CAD patients
ACE-I/ARB in CAD patients 77.6 ± 13.2
74.5 ± 10.1
with LV EF<40%
Lipid-lowering in CAD
patients
80.9 ± 11.6
79.8 ± 11.2
Provider category
Advanced practice Physician providers
providers
n = 146
n = 539
(35725 patients)
(355713 patients)
Blood pressure assessment
96.9 ± 7.6
94.3 ± 16.3
in CAD patients
All above CAD performance 10.2 ± 16.1
11.7 ± 17.5
measures met in eligible
Rate ratio*
(unadjusted)
[Physician
providers as
referent
category]
1.05 (1.02-
Rate ratio
(adjusted)†
[Physician
providers as
referent
category]
0.99 (0.98-
1.07)
0.99)
1.38 (0.84-
1.05 (0.82-
2.25)
1.36)
1.05 (0.99-
1.01 (0.97-
1.11)
1.04)
1.03 (0.99-
1.00 (0.99-
1.06)
1.02)
1.07 (1.02-
1.00 (0.97-
1.13)
1.03)
1.05 (0.99-
0.98 (0.95-
1.11)
1.02)
patients
ACE-I/ARB use in patients
83.8 ± 19.4
81.9 ± 16.1
with LVEF<40%
Beta-blocker use in patients
94.6 ± 9.9
94.0 ± 9.0
with LVEF<40%
Both HF measures performan 81.8 ± 20.7
79.8 ± 17.4
ce measures met
Anticoagulant use
in AF patients with CHADS2
62.8 ± 16.1
60.2 ± 15.9
score >2
*rate ratio = rate for compliance with a performance measure among advanced practice providers
/rate of compliance with a performance measure among physician providers
†adjusted for practice, provider gender, number of patients in provider panel in 2012, length of
PINNACLE registry participation, number of outpatient visits, patient’s age, gender, insurance,
history of diabetes, hypertension, myocardial infarction, and PCI or CABG in the last 12 months
CAD, coronary artery disease; MI, myocardial infarction; LVEF, left ventricular ejection
fraction; ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker
ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; HF, heart
failure; AF, atrial fibrillation; CHADs2 score for stroke risk assessment in atrial fibrillation
(congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke); PCI,
percutaneous coronary intervention; CABG, coronary artery bypass grafting