The 130th Annual Meeting of APHA

Abstract #41311

James M. Gill, MD, MPH, Health Services Research Group, Christiana Care Health Services, 1401 Foulk Road, Wilmington, DE 19803, 302-477-3324, jgill@christianacare.org, Arch G. Mainous, PhD, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425, James Diamond, PhD, Department of Family Medicine, Jefferson Medical College, 1015 Walnut Street, Philadelphia, PA 19107, and M. James Lenhard, MD, Diabetes & Metabolic Center, Christiana Care Health Services, 501 West 14th Street, Wilmington, DE 19801.

Background: Continuity of care is one of the core components of primary care. Higher continuity has been linked to improved recognition of medical problems, higher immunization rates, and fewer hospitalizations and emergency department visits, but has not been studied in terms of its impact on care for chronic diseases such as diabetes mellitus. The purpose of this study was to examine the association between continuity of care and the likelihood of receiving appropriate monitoring tests in a national population of privately insured persons with diabetes mellitus. Study Design: Cross sectional survey study, using administrative claims data. Continuity was measured as the concentration of outpatient care with an individual health care provider, and with a provider group or office. Population: All persons ages 18-64 years of age who were enrolled in a single national health plan through a single employer during a one year period (1/1/99-12/31/99), who were diagnosed with diabetes mellitus during the study year according to Health Plan Employer Data and Information Set (HEDIS) criteria, and who had made at least two outpatient visits during the study year (N=1786). Main Outcomes: Completion of each of three recommended tests for diabetes monitoring during the study year: glycosylated hemoglobin tests, lipid profile, and eye exam. Results: For the overall study population, 81 percent of persons had at least one glycosylated hemoglobin test, 66 percent had at least one lipid profile, and 28 percent had at least once eye exam during the study year. After controlling for age, gender, residence, specialty of the predominant provider, case mix and diabetes complications, continuity of care with an individual provider was not associated with the likelihood of receiving any of these three tests. Higher group continuity was associated with a significantly higher likelihood of having a glycosylated hemoglobin test during the study year (adjusted odds ratio=2.36, p=0.014), but was not associated with the likelihood of receiving a lipid profile or an eye exam. Conclusions: For persons with diabetes in a national private health plan, rates of appropriate monitoring tests are high for glycosylated hemoglobin but low for eye exams and intermediate for lipid profile. Continuity of care was not consistently associated with a higher likelihood of receiving any of the tests studied. While continuity may have other benefits, improving the rates of diabetes monitoring tests does not appear to be one of these benefits.

Learning Objectives:

• Patients will understand how administative claims data can be used to measure quality of care for chronic conditions such as diabetes
• Participants will understand the concept of continuity of care, and how continuity can have an impact on quality of care for chronic conditions such as diabetes.
• Participants willlearn how quality of care for diabetes varies for a national population of privately insured patients, and how this variablility is related to provider continuity and provider specialty.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.