Patient complexity and diabetes quality of care in rural settings
Department of Quantitative Health Sciences
Medical Subject Headings
Age Factors; Aged; Alabama; Data Interpretation, Statistical; Diabetes Mellitus; Female; Hemoglobin A, Glycosylated; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Physician's Practice Patterns; Primary Health Care; *Quality of Health Care; Randomized Controlled Trials as Topic; Risk Factors; Rural Health Services; Rural Population; United States
Biostatistics | Endocrine System Diseases | Epidemiology | Health Services Research | Nutritional and Metabolic Diseases
PURPOSE: Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States.
BASIC PROCEDURES: Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice's proportion of patients having controlled diabetes (hemoglobin A1c
MAIN FINDINGS: Rural primary care practices (n=135) in 11 southeastern states provided information for 1641 patients with diabetes. For practices in the best quartile of observed control, 76.1% of patients had controlled diabetes vs 19.3% of patients in the worst quartile. After controlling for other variables, proportions of diabetes control were 10% lower in those practices whose patients had the greatest difficulty with either self testing or appointment keeping (p
PRINCIPAL CONCLUSIONS: Basing public reporting and resource allocation on quality assessment that does not account for patient characteristics may further harm this vulnerable group of patients and physicians.