Are Physician Reimbursement Strategies Associated with Processes of Care and Patient Satisfaction for Patients with Diabetes in Managed Care?

Ettner, Susan L.; Thompson, Theodore; Stevens, Mark R.; Mangione, Carol M.; Kim, Catherine; Steers, W. Neil; Goewey, Jennifer; Brown, Arleen F.; Chung, Richard; Narayan, K.M. Venkat

doi:10.1111/j.1475-6773.2006.00533.x

Cited by 20 publications

(19 citation statements)

References 44 publications

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“…Several studies conducted in the United States have demonstrated that practices that primarily pay their physicians through direct salary provide strong diabetes care [21-23]. The CHC's payment structure, organizational structure and care delivery approach which includes team care, focused clinics and the use of an EMR is likely a strong contributor to the observed differences in quality of diabetes care delivery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

et al. 2011

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BackgroundPrimary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models.MethodsThis is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models.ResultsThe percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management.ConclusionsThis study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.Trial RegistrationClinicalTrials.gov: NCT00574808

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Section: Discussionmentioning

confidence: 99%

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

et al. 2011

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“…Health system factors in particular have received very little attention for their potential direct and indirect effects upon diabetes and depression treatment, quality of care and outcomes. The impact of these potentially confounding factors, such as benefit structure, co-pay amounts, requirements for pre-approval of specialist care, and the use of electronic medical record systems [27–29,37,38] are difficult to take into consideration in studies of single health care plans.…”

Section: Discussionmentioning

confidence: 99%

Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study

Waitzfelder

Gerzoff²,

Karter

et al. 2010

Primary Care Diabetes

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Aim The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristics; (2) outcomes; and (3) diabetes-related quality of care. Methods Cross-sectional analyses were performed using survey and chart data from the Translating Research Into Action for Diabetes (TRIAD) study, including 8790 adults with diabetes, enrolled in 10 managed care health plans in 7 states. Depression was measured using the Patient Health Questionnaire (PHQ-8). Patient characteristics, outcomes and quality of care were measured using validated survey items and chart data. Results Nearly 18% of patients had major depression, with prevalence 2-3 times higher among patients with low socioeconomic status. Pain and limited mobility were strongly associated with depression, controlling for other patient characteristics. Depression was associated with slightly worse glycemic control, but not other intermediate clinical outcomes. Depressed patients received slightly fewer recommended diabetes-related processes of care. Conclusions In a large, diverse cohort of patients with diabetes, depression was most prevalent among patients with low socioeconomic status and those with pain, and was associated with slightly worse glycemic control and quality of care.

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“…30 In the USA, FFS payment mechanisms have been found to be associated with poorer adherence to recommended processes of diabetes care and may also lead to relatively poor documentation of unreimbursed services. 31 Unlike in the UK, the US health system is neither based on primary care nor does it protect its financing from hospital and subspecialty services. These system-level differences, coupled with the UK investments in primary care, are likely among the determinants of the differences in quality observed here.…”

Section: Discussionmentioning

confidence: 99%

A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives

Crosson¹,

Ohman‐Strickland²,

Campbell

et al. 2009

Family Practice

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comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives. Family Practice 2009; 26: 510-516. Background. The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown. Objective. To compare US and UK practices on P4P measures prior to program implementation.Methods. We analysed medical record data collected before QOF implementation from randomly selected patients with diabetes or coronary artery disease (CAD) in 42 UK and 55 US family medicine practices. We compared care processes and intermediate outcomes using hierarchical logistic regression. Results. While we found gaps in chronic illness care quality across both samples, variation was lower in UK practices. UK patients were more likely to receive recommended care processes for diabetes [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.26-18.74] and CAD (OR, 9.18; 95% CI, 5.22-16.17) but less likely to achieve intermediate diabetes outcome targets (OR, 0.50; 95% CI, 0.39-0.64). Conclusions. Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes.

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Are Physician Reimbursement Strategies Associated with Processes of Care and Patient Satisfaction for Patients with Diabetes in Managed Care?

Cited by 20 publications

References 44 publications

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study

A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives

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