Patient complexity and diabetes quality of care in rural settings

UMMS Affiliation

Department of Quantitative Health Sciences

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Document Type



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.


UMCCTS funding


J Natl Med Assoc. 2011 Mar;103(3):234-40.

Journal/Book/Conference Title

Journal of the National Medical Association

PubMed ID


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Link to Article in PubMed