OBJECTIVE -To describe the extent of adoption of diabetes care management processes in physician organizations in the U.S. and to investigate the organizational factors that affect the adoption of diabetes care management processes. A total of 1,104 of the 1,590 physician organizations identified responded to the survey. The extent of adoption of four diabetes care management processes is measured by an index consisting of the organization's use of diabetic patient registries, clinical practice guidelines, case management, and physician feedback. The ordinary least-squares model is used to determine the association of organizational characteristics with the adoption of diabetes care management processes in physician organizations. A logistic regression model is used to determine the association of organizational characteristics with the adoption of individual diabetes care management processes. RESEARCH DESIGN AND METHODSRESULTS -Of the 987 physician organizations studied that treat patients with diabetes, 48% either do not use any or use only one of the four diabetes care management processes. A total of 20% use two care management processes, and 32% use three or four processes. External incentives to improve quality, computerized clinical information systems, and ownership by hospitals or health maintenance organizations are strongly associated with the diabetes care management index and the adoption of individual diabetes care management processes.CONCLUSIONS -Policies to encourage external incentives to improve quality and to facilitate the adoption of computerized clinical information technology may promote greater use of diabetes care management processes. Diabetes Care 27:2312-2316, 2004A large body of evidence suggests that diabetes is inadequately managed in the U.S. In a 1999 -2000 randomly sampled survey of 488 adults with diabetes living in 12 metropolitan areas in the U.S., followed by a review of many of their medical charts, only 45% of recommended processes of diabetes care were delivered. Only 24% of adults with diabetes underwent three or more HbA 1c tests over a 2-year period (1).Data from the 1999 -2000 National Health and Nutrition Examination Survey (NHANES) show that 37% of patients with diabetes achieved the target goal of HbA 1c level Ͻ7.0% and 37% had HbA 1c levels Ͼ8.0%, percentages that did not change significantly from a similar 1988 -1994 national survey. A total of 36% of patients with diabetes had normal blood pressure (Ͻ130/80 mmHg), whereas 40% had elevated blood pressure (Ն140/90 mmHg). Of the study subjects, 52% had total cholesterol levels Ն200 mg/dl. Only 7% of adults with diabetes in 1999 -2000 attained recommended goals of HbA 1c , blood pressure, and total cholesterol (2).The locus of actual care delivery for much of diabetes management is the physician organization. No large-scale surveys have previously been conducted to determine the extent to which physician organizations have adopted innovations known to improve the care of diabetes. It is also not known which organi...

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Th e COVID-19 pandemic has brought about a precipitous transformation in health care delivery in the nation's safety-net, primary care system of federally qualifi ed health centers (FQHCs). Th is study uses electronic health record data to quantify the extent of changes to visit volume in 36 FQHCs across 19 states as well as changes in quality metrics. We found a steep decline in in-person visits in March 2020 accompanied by a sharp increase in telehealth visits; however, combined volume remained 23% below pre-pandemic levels. Th e implications for public health are signifi cant, as preventive and chronic care deferral could lead to exacerbations of health disparities. Our examination of the impact on quality measures suggests that gaps in care are already emerging. Services that cannot be readily performed virtually are most aff ected. As FQHC visit numbers recover, concerted eff orts are needed to encourage access and re-engage at-risk groups that fell out of care.

Because external incentives are strong drivers of adoption, policies requiring reporting of chronic care measurements and rewarding improvement as well as financial incentives for use of specific information technology tools are likely to accelerate adoption of order entry with decision support.