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Journal article
Quantifying the primary care workforce in the U.S.: A validation study with and without an imperfectly measured referent standard
Annals of epidemiology, v 108, pp 92-98
Aug 2025
PMID: 40562324
Featured in Collection : Research Supported by Drexel Libraries' OA Programs
Abstract
Purpose
To validate the National Provider Identifier (NPI), a commonly used data source in health services research, for identifying primary care physicians, physician assistants (PAs), and nurse practitioners (NPs).
Methods
Validation studies to calculate the sensitivity, specificity, and associated 95% confidence intervals for physicians, PAs, and NPs. For physicians, Medicare claims data were used as an imperfectly measured referent standard. For PAs and NPs, we used a simulation-based method to estimate accuracy parameters that assumed the NPI and Medicare claims were equally misclassified.
Results
Using the Medicare claims as the referent standard for physicians yielded a sensitivity and specificity of 0.95 (95% CI: 0.88, 0.98) and 0.76 (95% CI: 0.73, 0.79), respectively. Using the simulation-based method yielded a sensitivity and specificity of 0.57 (95% CrI: 0.11, 0.97) and 0.56 (95% CrI: 0.10, 0.96), respectively for PAs and 0.58 (95% CrI: 0.13, 0.97) and 0.61 (95% CrI: 0.14, 0.97), respectively for NPs.
Conclusions
Our validation results varied by provider role. Accuracy was highest for physicians further highlighting the challenges in quantifying PAs and NPs based on their NPI alone. Failure to consider potential misclassification in the NPI may result in biased research findings.
Metrics
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Details
- Title
- Quantifying the primary care workforce in the U.S.: A validation study with and without an imperfectly measured referent standard
- Creators
- Nicole Rafalko - Drexel UniversityScott D. Siegel - Christiana Care Health SystemPaul YerkesJan Eberth - Drexel University, Health Management and PolicyIgor Burstyn - Drexel University, Environmental and Occupational HealthNeal Goldstein (Corresponding Author) - Drexel University, Epidemiology and Biostatistics
- Publication Details
- Annals of epidemiology, v 108, pp 92-98
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- NIH: P20 GM103446 State of Delaware
This project was supported in part by NIGMS (P20 GM103446) from the NIH and the State of Delaware (to S.D. Siegel)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics; Health Management and Policy; Environmental and Occupational Health
- Web of Science ID
- WOS:001525449200001
- Scopus ID
- 2-s2.0-105009239825
- Other Identifier
- 991022058838204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health