Managed Care Organization and the Quality of Diabetes Care

Abstract

OBJECTIVE -To examine the association between the organizational model and diabetes processes of care.RESEARCH DESIGN AND METHODS -We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8,354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA 1c testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language.RESULTS -Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P Ͻ 0.0001), and group/network models generally increased the probability of receiving a process by Ն10 percentage points. Among nonprofit plans, no effect of model type was found.CONCLUSIONS -Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.

Thoracic Endometriosis Syndrome: Case Report and Review of the Literature

“…Seven studies suggested clinical integration as a possible reason for better performance. 19,27,58,61,62,70,74 The use of technology (ie, electronic alerts, health information technology, EHR, secure messaging, remote video technology) was another common attribute cited across studies. e Last, a comprehensive approach to care delivery (ie, multidisciplinary care teams, comprehensive care management, interdisciplinary treatment, multimodal interventions) and self-management were other themes highlighted as possibly improving patient outcomes.…”

A Novel Use of Foley Catheters to Prevent Injury to the Pelvic Viscera During Stereotactic Radiosurgery for Undifferentiated Pleomorphic Sarcoma of the Sacrum

“…55,58,62,63,[70][71][72][73][74][75][76][77] Among the different topical areas that the comparative health systems studies covered, the most frequently studied topic was quality of care (n = 30) a and articles that related to health information technology/EHR/clinical decision support/telemedicine (n = 18). b Other commonly studied topics included resource use (cost/utilization; n = 16), c health systems performance (n = 7), 14,59,61,70,72,73,76 and disease management (n = 7). 13,15,17,25,36,40,47 On the basis of disease or type of condition, diabetes mellitus was the most frequently studied (n = 11).…”

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

“…[26][27][28][29] We measured A1c, LDL, and systolic blood pressure (SBP) as intermediate outcomes of diabetes care. [30][31][32][33] Each patient could have zero, one, or multiple values available for each laboratory variable. If multiple values were available on the same day, we used the mean of the measures.…”

“…Adjustment using medication intensity has become a standard in Translating Research into Action for Diabetes (TRIAD) and other studies of diabetes care quality. 31,33 Clinic level variables included the number of annual visits per clinic site, ratio of support staff full time equivalent (FTEs) to MD FTE, [37][38][39] and physician productivity, which is defined as the ratio of total Relative Value Units (RVUs) to MD FTE. Clinical systems may differ in process and outcomes of care when there are differences in the overall case mix of the clinic (i.e., provider exposure to other patients beyond the analytic sample).…”