Patient complexity and diabetes quality of care in rural settings
Department of Quantitative Health Sciences
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.
Journal of the National Medical Association
Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Williams, Jessica H.; Ovalle, Fernando; Payne-Foster, Pamela; Allison, Jeroan J.; and Estrada, Carlos A., "Patient complexity and diabetes quality of care in rural settings" (2011). Quantitative Health Sciences Publications and Presentations. 1000.