Trends in weight assessment and counseling among Medicaid beneficiaries with diabetes: An evaluation of a population health oriented information technology initiative
Compare rates of weight assessment and nutritional/ physical activity counseling, among Medicaid beneficiaries whose primary care providers are participating in PCIP to beneficiaries whose primary care providers are not.
Among Medicaid beneficiaries, 18-64 years, in New York City, rates of adjudicated claims for weight assessment and nutritional/ physical activity counseling were compared between PCIP and non-PCIP primary care providers (i.e., family medicine, internal medicine, pediatrics, or general practice) stratified by the presence of medical conditions for which these services are recommended to improve health outcomes. Overall, ~1,900 PCIP providers treated ~135,000 and ~1,600 non-PCIP providers treated ~115,000 beneficiaries per year. Rates were compared for groups of beneficiaries by clinician, at baseline (2008) and end-of-study (2013).
Significantly larger increases (p-value <0.05) were observed among PCIP beneficiaries, particularly for those with diabetes, for weight assessments [PCIP/baseline= 1.52% (percent increase= +20.37%); non-PCIP/ 0.97% (+11.67%)]; and for nutritional/ physical activity counseling [PCIP/ 6.32% (+4.10%); non-PCIP/ 3.16% (+2.95%)], although at baseline both groups had very low rates of adjudicated claims for these types of services. For hemoglobin A1c testing, the two groups had similar levels of improvement over time [PCIP/ 77.27% (+7.82%); non-PCIP/ 76.22% (+7.77%)].
Counseling for weight management, good nutrition and regular exercise are associated with improved health outcomes for those with diabetes. Yet, services aimed at addressing these issues are not regularly delivered. Although overall rates remain low, results of this study suggest that provider participation in a quality improvement initiative utilizing health information technology is associated with increased preventive services utilization in primary care settings.
Learning Areas:Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research
List recommended guidelines for weight management, and nutritional/ physical activity counseling for the all individuals, and for individuals with chronic conditions, such as diabetes. Describe the methods used in the electronic health record (EHR), and by the quality improvement program to improve weight assessment and preventive services utilization in the primary care setting. Discuss the potential impact of a population health-oriented quality improvement initiative on rates of weight assessment and nutritional/ physical activity counseling in the primary care setting.
Keyword(s): Diabetes, Weight Management
Qualified on the content I am responsible for because: I have been a prinicpal or co-principal researcher in the evaluation of health information technology programs affiliated with the New York City Department of Health & Mental Hygiene. My scientific interests include the impact of evolving health information technology on patient quality of care in medically underserved communities.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.