# Impact of Primary Care Clinician Interdependence and Coordination on Quality of Care Delivered to Complex Older Patients with Diabetes > **NIH NIH K01** · DUKE UNIVERSITY · 2020 · $122,283 ## Abstract ABSTRACT A shortage of primary care physicians makes it difficult to deliver quality diabetes care to America’s aging population. A frequently recommended approach to compensate for escalating primary care physician shortages, while still meeting the chronic illness care needs of an aging population, is to incorporate physician assistants (PAs) and nurse practitioners (NPs) into primary care teams. While a number of team models incorporating PA&NPs have delivered quality care to patients with chronic illnesses such as diabetes, data is limited regarding which clinician team approaches are most effective. Identifying effective approaches to incorporating PA&NPs into primary care teams that care for older patients will require identification of effective PA&NP roles, as well as features of PA&NP and physician interaction (interdependence and coordination) that can improve patient outcomes. Interdependence between primary care PA&NPs and physicians occurs when they provide care to, or “share” common patients. Managing shared patients between clinicians requires coordination. Coordination can be accomplished through multiple methods including routines (ex: clinical pathways), boundary spanners (ex: case managers), team meetings (ex: huddles), and relational coordination (i.e., communication and relationships) and is believed to be a key mechanism by which clinician teams will improve patient outcomes, particularly for older, complex patients with multiple chronic conditions. Focus has been placed on improving patient outcomes by coordinating care between settings, such as between specialists and primary care. To our knowledge, however, no studies have evaluated the impact of interdependence and/or coordination within primary care on patient diabetes outcomes such as glycemic and lipid control or development of patient treatment goals. My long-term goal is to improve chronic illness care for older complex patients through identification and implementation of effective primary care teams. In order to develop and evaluate team interventions, it is critical to address the medical and social aspects of team-based care delivery. Designing and evaluating interventions that address both aspects of team care require a range of knowledge and skills, including expertise in mixed methods research approaches, organizational theory, and implementation science. The objective of this application is to determine if PA&NP and physician interaction (interdependence and coordination) on teams impacts outcomes for older patients with diabetes. My health policy background, clinical experience as a PA, and formal quantitative research training will provide the foundation for the proposed project. I will pursue career development in mixed methods, and implementation science and organizational theory at both Duke University and the University of North Carolina Chapel Hill (UNC). The specific aims of the proposed project are to describe the methods of coordination utilize... ## Key facts - **NIH application ID:** 9908029 - **Project number:** 5K01AG053378-05 - **Recipient organization:** DUKE UNIVERSITY - **Principal Investigator:** Christine M Everett - **Activity code:** K01 (R01, R21, SBIR, etc.) - **Funding institute:** NIH - **Fiscal year:** 2020 - **Award amount:** $122,283 - **Award type:** 5 - **Project period:** 2016-08-01 → 2022-01-31 ## Primary source NIH RePORTER: https://reporter.nih.gov/project-details/9908029 ## Citation > US National Institutes of Health, RePORTER application 9908029, Impact of Primary Care Clinician Interdependence and Coordination on Quality of Care Delivered to Complex Older Patients with Diabetes (5K01AG053378-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9908029. Licensed CC0. --- *[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*