“Diabetes-Specific Experience” Linked to Quality of Diabetes Care

The quality of primary care management of diabetes is lower for physicians with higher-volume practices, but higher for those with greater diabetes-specific volume, reports a study in Annals of Internal Medicine.

Using Ontario health databases, the researchers analyzed data on more than 1 million adults with diabetes who received care from approximately 9000 primary care physicians during 2011. For each physician, overall ambulatory volume and diabetes-specific volume were assessed. These two measures were analyzed for association with six selected indicators of quality of diabetes care, addressing disease monitoring, prescription of appropriate medications, and adverse clinical outcomes.

For most indicators, overall ambulatory volume was inversely related to quality of diabetes care. The trend did not reach significance for adverse clinical outcomes (emergency department visits for hypoglycemia or hyperglycemia).

In contrast, diabetes-specific volume was directly related to quality of diabetes care,” the researchers write. This was so for all six indicators studied. The associations were independent of each other and were unaffected by cardiovascular disease status or socioeconomic factors.

Little is known about whether physician volume affects the outcomes of outpatient care for diabetes or other chronic diseases. The new analysis suggests that primary care doctors with an overall higher patient volume deliver lower-quality diabetes care.

The results also show that physicians with greater diabetes-specific experience deliver consistently better diabetes care, including lower rates of adverse clinical outcomes. “Health policies or programs to support physicians with low volume of patients with diabetes may improve care,” according to the authors [Cheung A, et al. Primary care physician volume and quality of diabetes care: a population-based cohort study. Ann Intern Med 2016; DOI: 10.7326/M16-1056].