Variation in Quality of Diabetes Care
Author Information
Author(s): O'Connor Patrick J, Rush William A, Solberg Leif I, Whitebird Robin R, Crain A Lauren, Davidson Gestur, Johnson Paul E, Louis Thomas A
Primary Institution: HealthPartners Research Foundation
Hypothesis
We studied variance in glycated hemoglobin (HbA1c) values among adults with diabetes to identify variation in quality of diabetes care at the levels of patient, physician, and clinic.
Conclusion
Most variance in HbA1c values is attributable to patient factors, although physicians influence some of these factors.
Supporting Evidence
- More than 95% of variance in HbA1c values was attributable to the patient level.
- Intensification of pharmacotherapy was related to favorable change in HbA1c.
- Physician age and specialty did not predict change in HbA1c value.
Takeaway
This study found that how well diabetes is managed often depends more on the individual patient than on their doctor or clinic.
Methodology
The study used multivariate hierarchical models to analyze HbA1c values across patient, physician, and clinic levels.
Potential Biases
The statistical models may underestimate physician-level variance and overestimate patient-level variance.
Limitations
The study did not consider factors such as days between visits, adherence to treatment, health literacy, or quality of life.
Participant Demographics
Adults with diabetes, average age around 60 years, with a mix of comorbidities.
Statistical Information
P-Value
p<0.01
Statistical Significance
p<0.05
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