 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Comparing the Quality of Diabetes Care by Generalists and Specialists
15 January 2002 | Volume 136 Issue 2 | Page I42
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Profiling Care Provided by Different Groups of Physicians: Effects of Patient Case-Mix (Bias) and Physician-Level Clustering on Quality Assessment Results." It is in the 1 January 2002 issue of Annals of Internal Medicine (volume 136, pages 111-121). The authors are S Greenfield, SH Kaplan, R Kahn, J Ninomiya, and JL Griffith.
What is the problem and what is known about it so far?
Comparisons of the quality of care that different types of doctors (for example, primary care doctors and specialists) provide for chronic illnesses, such as diabetes, must be done carefully. First, different types of patients may tend to see different types of doctors. For example, older patients or patients with multiple health problems may seek care from primary care doctors, who will care for all of their problems, instead of from endocrinologists, who would care only for the diabetes. In addition, not all doctors in a specialty practice alike. For this reason, comparisons of quality of care need to consider the fact that patients who see the same doctor are likely to get similar care, a concept known as "physician-level clustering."
Why did the researchers do this particular study?
To compare the quality of diabetes care provided by generalists and by specialists, in this case endocrinologists, taking into account patient factors and physician-level clustering.
Who was studied?
The researchers studied 1750 adult patients with diabetes who received care in 15 endocrinology practices and 14 primary care practices in the United States. The patients were participating in a national study of the quality of diabetes care.
How was the study done?
Using medical records and patient surveys, the researchers collected information on the following components of good diabetes care: measurement of hemoglobin A1c levels (a measure of sugar control), cholesterol levels, urine protein levels (to look for diabetic kidney disease), blood pressure, foot examinations, and eye examinations. They also collected information about whether blood sugar, blood pressure, and cholesterol levels were in good control and about patients' satisfaction with their health care.
What did the researchers find?
When the researchers did not consider patient factors and physician-level clustering, endocrinologists appeared to provide better care for diabetes than primary care doctors did. However, statistically speaking, the differences between the two types of doctors became insignificant when the researchers considered both patient factors and physician-level clustering. The main reason that the researchers could not detect differences between specialties was that the individual styles of physicians within each specialty varied considerably.
What were the limitations of the study?
The study included only 29 care sites. These findings might not apply to other types of doctors.
What are the implications of the study?
In careful analyses that consider both patient factors and the fact that patients of the same doctor are likely to get similar care, meaningful differences in the quality of diabetes care provided by generalists and endocrinologists will be difficult to see. Comparisons of groups of doctors that do not consider these factors may come to wrong conclusions about the care provided by different types of doctors.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  M. L. Maciejewski, C.-F. Liu, and S. D. Fihn Performance of Comorbidity, Risk Adjustment, and Functional Status Measures in Expenditure Prediction for Patients With Diabetes Diabetes Care, January 1, 2009; 32(1): 75 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Miles Health Information Systems and Physician Quality: Role of the American Board of Pediatrics Maintenance of Certification in Improving Children's Health Care Pediatrics, January 1, 2009; 123(Supplement_2): S108 - S110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. van Bruggen, K. J Gorter, R. P Stolk, R. P Verhoeven, and G. E H M Rutten Implementation of locally adapted guidelines on type 2 diabetes Fam. Pract., December 1, 2008; 25(6): 430 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Resnik, D. Liu, D. L Hart, and V. Mor Benchmarking Physical Therapy Clinic Performance: Statistical Methods to Enhance Internal Validity When Using Observational Data Physical Therapy, September 1, 2008; 88(9): 1078 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Holmboe, Y. Wang, T. P. Meehan, J. P. Tate, S.-Y. Ho, K. S. Starkey, and R. S. Lipner Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries Arch Intern Med, July 14, 2008; 168(13): 1396 - 1403. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Pakhomov, S. Bjornsen, P. Hanson, and S. Smith Quality Performance Measurement Using the Text of Electronic Medical Records Med Decis Making, July 1, 2008; 28(4): 462 - 470. [Abstract] [PDF]
|
|
|
|
|
|
T. D. Sequist, G. M. Fitzmaurice, R. Marshall, S. Shaykevich, D. G. Safran, and J. Z. Ayanian Physician Performance and Racial Disparities in Diabetes Mellitus Care Arch Intern Med, June 9, 2008; 168(11): 1145 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Brown, T Hofer, A Johal, R Thomson, J Nicholl, B D Franklin, and R J Lilford An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement Qual. Saf. Health Care, June 1, 2008; 17(3): 170 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. E. Landon and S.-L. T. Normand Performance Measurement in the Small Office Practice: Challenges and Potential Solutions Ann Intern Med, March 4, 2008; 148(5): 353 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. J. Fochtmann, F. F. Duffy, J. C. West, R. Kunkle, and R. M. Plovnick Performance in Practice: Sample Tools for the Care of Patients with Major Depressive Disorder Focus, January 1, 2008; 6(1): 22 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Turchin, M. Shubina, and M. L. Pendergrass Relationship of Physician Volume With Process Measures and Outcomes in Diabetes Diabetes Care, June 1, 2007; 30(6): 1442 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Aron and L. Pogach Specialists versus generalists in the era of pay for performance: "A plague o' both your houses!" Qual. Saf. Health Care, February 1, 2007; 16(1): 3 - 5. [Full Text] [PDF]
|
|
|
|
|
|
F A McAlister, S R Majumdar, D T Eurich, and J A Johnson The effect of specialist care within the first year on subsequent outcomes in 24 232 adults with new-onset diabetes mellitus: population-based cohort study Qual. Saf. Health Care, February 1, 2007; 16(1): 6 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Nutting, W. P. Dickinson, L. M. Dickinson, C. C. Nelson, D. K. King, B. F. Crabtree, and R. E. Glasgow Use of Chronic Care Model Elements Is Associated With Higher-Quality Care for Diabetes Ann. Fam. Med, January 1, 2007; 5(1): 14 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Piatt, J. C. Zgibor, and M. M. Brooks Translating the Chronic Care Model Into the Community: Results From a Randomized Controlled Trial of a Multifaceted Diabetes Care Intervention: Response to Belalcazar and Swank Diabetes Care, December 1, 2006; 29(12): 2762 - 2762. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Durairaj, J. C. Torner, E. A. Chrischilles, M. S. Vaughan Sarrazin, J. Yankey, and G. E. Rosenthal Hospital Volume-Outcome Relationships Among Medical Admissions to ICUs Chest, September 1, 2005; 128(3): 1682 - 1689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. O'Connor, J. Desai, L. I. Solberg, L. A. Reger, A. L. Crain, S. E. Asche, T. L. Pearson, C. K. Clark, W. A. Rush, L. M. Cherney, et al. Randomized Trial of Quality Improvement Intervention to Improve Diabetes Care in Primary Care Settings Diabetes Care, August 1, 2005; 28(8): 1890 - 1897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kim, L. N. McEwen, R. B. Gerzoff, D. G. Marrero, C. M. Mangione, J. V. Selby, and W. H. Herman Is Physician Gender Associated With the Quality of Diabetes Care? Diabetes Care, July 1, 2005; 28(7): 1594 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Franks, K. Fiscella, C. G. Shields, S. C. Meldrum, P. Duberstein, A. F. Jerant, D. J. Tancredi, and R. M. Epstein Are Patients' Ratings of Their Physicians Related to Health Outcomes? Ann. Fam. Med, May 1, 2005; 3(3): 229 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J Lee and S. G Thompson The use of random effects models to allow for clustering in individually randomized trials Clinical Trials, April 1, 2005; 2(2): 163 - 173. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. Ezekowitz, C. van Walraven, F. A. McAlister, P. W. Armstrong, and P. Kaul Impact of specialist follow-up in outpatients with congestive heart failure Can. Med. Assoc. J., January 18, 2005; 172(2): 189 - 194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J Lee and S. G Thompson Clustering by health professional in individually randomised trials BMJ, January 15, 2005; 330(7483): 142 - 144. [Full Text] [PDF]
|
|
|
|
|
|
S. Greenfield and S. H. Kaplan Creating a Culture of Quality: The Remarkable Transformation of the Department of Veterans Affairs Health Care System Ann Intern Med, August 17, 2004; 141(4): 316 - 318. [Full Text] [PDF]
|
|
|
|
|
|
G. De Berardis, F. Pellegrini, M. Franciosi, M. Belfiglio, B. Di Nardo, S. Greenfield, S. H. Kaplan, M. C.E. Rossi, M. Sacco, G. Tognoni, et al. Quality of Care and Outcomes in Type 2 Diabetic Patients: A comparison between general practice and diabetes clinics Diabetes Care, February 1, 2004; 27(2): 398 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Schoenbaum, A.-M. J. Audet, and K. Davis Obtaining Greater Value From Health Care: The Roles Of The U.S. Government Health Aff., November 1, 2003; 22(6): 183 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S. Panageas, D. Schrag, E. Riedel, P. B. Bach, and C. B. Begg The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes Ann Intern Med, October 21, 2003; 139(8): 658 - 665. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Gill, A. G. Mainous III, J. J. Diamond, and M. J. Lenhard Impact of Provider Continuity on Quality of Care for Persons With Diabetes Mellitus Ann. Fam. Med, September 1, 2003; 1(3): 162 - 170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Jong, Y. Gong, P. P. Liu, P. C. Austin, D. S. Lee, and J. V. Tu Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists Circulation, July 15, 2003; 108(2): 184 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Davidson The Case for "Outsourcing" Diabetes Care Diabetes Care, May 1, 2003; 26(5): 1608 - 1612. [Full Text] [PDF]
|
|
|
|
|
|
I. B. Hirsch The Burden of Diabetes (Care) Diabetes Care, May 1, 2003; 26(5): 1613 - 1614. [Full Text] [PDF]
|
|
|
|
|
|
N. Goldfield, S. Gnani, and A. Majeed Primary care in the United States: Profiling performance in primary care in the United States BMJ, April 5, 2003; 326(7392): 744 - 747. [Full Text] [PDF]
|
|
|
|
|
|
S. W. Klarenbach and P. Jacobs International Comparison of Health Resource Utilization in Subjects With Diabetes: An analysis of Canadian and American national health surveys Diabetes Care, April 1, 2003; 26(4): 1116 - 1122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Mor, K. Berg, J. Angelelli, D. Gifford, J. Morris, and T. Moore The Quality of Quality Measurement in U.S. Nursing Homes Gerontologist, April 1, 2003; 43(90002): 37 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Califf and D. P. Faxon Need for Centers to Care for Patients With Acute Coronary Syndromes Circulation, March 25, 2003; 107(11): 1467 - 1470. [Full Text] [PDF]
|
|
|
|
|
|
A. A. Rothman and E. H. Wagner Chronic Illness Management: What Is the Role of Primary Care? Ann Intern Med, February 4, 2003; 138(3): 256 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Cobin Subspecialist Care Improves Diabetes Outcomes Diabetes Care, September 1, 2002; 25(9): 1654 - 1656. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Mahadevia, S. Himelhoch, and J. Braunstein Quality of Care in Patients with Diabetes Ann Intern Med, July 2, 2002; 137(1): 70 - 70. [Full Text] [PDF]
|
|
|
|
|
|
S. Weir, R. Stone, P. Levy, S. F. Hodgson, and B. Fleming Quality of Care in Patients with Diabetes Ann Intern Med, July 2, 2002; 137(1): 71 - 71. [Full Text] [PDF]
|
|
|
|
|
|
R. H. Cobin and H. W. Rodbard Quality of Care in Patients with Diabetes Ann Intern Med, July 2, 2002; 137(1): 70 - 71. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Eisenberg Measuring Quality: Are We Ready To Compare the Quality of Care among Physician Groups? Ann Intern Med, January 15, 2002; 136(2): 153 - 154. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
