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Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes

IMPORTANCE: Clinical practice group performance on quality measures associated with chronic disease management has become central to reimbursement. Therefore, it is important to determine whether commonly used process and disease control measures for chronic conditions correlate with utilization-bas...

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Autores principales: Gilstrap, Lauren G., Chernew, Michael E., Nguyen, Christina A., Alam, Sartaj, Bai, Barbara, McWilliams, J. Michael, Landon, Bruce E., Landrum, Mary Beth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694385/
https://www.ncbi.nlm.nih.gov/pubmed/31411713
http://dx.doi.org/10.1001/jamanetworkopen.2019.9139
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author Gilstrap, Lauren G.
Chernew, Michael E.
Nguyen, Christina A.
Alam, Sartaj
Bai, Barbara
McWilliams, J. Michael
Landon, Bruce E.
Landrum, Mary Beth
author_facet Gilstrap, Lauren G.
Chernew, Michael E.
Nguyen, Christina A.
Alam, Sartaj
Bai, Barbara
McWilliams, J. Michael
Landon, Bruce E.
Landrum, Mary Beth
author_sort Gilstrap, Lauren G.
collection PubMed
description IMPORTANCE: Clinical practice group performance on quality measures associated with chronic disease management has become central to reimbursement. Therefore, it is important to determine whether commonly used process and disease control measures for chronic conditions correlate with utilization-based outcomes, as they do in acute disease. OBJECTIVE: To examine the associations among clinical practice group performance on diabetes quality measures, including process measures, disease control measures, and utilization-based outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional analysis examined commercial claims data from a national health insurance plan. A cohort of eligible beneficiaries with diabetes aged 18 to 65 years who were enrolled for at least 12 months from January 1, 2010, through December 31, 2014, was defined. Eligible beneficiaries were attributed to a clinical practice group based on the plurality of their primary care or endocrinology office visits. Data were analyzed from October 1, 2018, through April 30, 2019. MAIN OUTCOMES AND MEASURES: For each clinical practice group, performance on current diabetes quality measures included 3 process measures (2 testing measures [hemoglobin A(1c) {HbA(1c)} and low-density lipoprotein {LDL} testing] and 1 drug use measure [statin use]) and 2 disease control measures (HbA(1c) <8% and LDL level <100 mg/dL). The rates of utilization-based outcomes, including hospitalization for diabetes and major adverse cardiovascular events (MACEs), were also measured. RESULTS: In this cohort of 652 258 beneficiaries with diabetes from 886 clinical practice groups, 42.9% were aged 51 to 60 years, and 52.6% were men. Beneficiaries lived in areas that were predominantly white (68.1%). At the clinical practice group level, except for high correlation between the 2 testing measures, correlations among different quality measures were weak (r range, 0.010-0.244). Rate of HbA(1c) of less than 8% had the strongest correlation with hospitalization for MACE (r = −0.046; P = .03) and diabetes (r = −0.109; P < .001). Rates of HbA(1c) control at the clinical practice group level were not significantly associated with likelihood of hospitalization at the individual level. Performance on the process and disease control measures together explained 3.9% of the variation in the likelihood of hospitalization for a MACE or diabetes at the individual level. CONCLUSIONS AND RELEVANCE: In this study, performance on utilization-based measures—intended to reflect the quality of chronic disease management—was only weakly associated with direct measures of chronic disease management, namely, disease control measures. This correlation should be considered when determining the degree of financial emphasis to place on hospitalization rates as a measure of quality in treatment of chronic diseases.
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spelling pubmed-66943852019-08-28 Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes Gilstrap, Lauren G. Chernew, Michael E. Nguyen, Christina A. Alam, Sartaj Bai, Barbara McWilliams, J. Michael Landon, Bruce E. Landrum, Mary Beth JAMA Netw Open Original Investigation IMPORTANCE: Clinical practice group performance on quality measures associated with chronic disease management has become central to reimbursement. Therefore, it is important to determine whether commonly used process and disease control measures for chronic conditions correlate with utilization-based outcomes, as they do in acute disease. OBJECTIVE: To examine the associations among clinical practice group performance on diabetes quality measures, including process measures, disease control measures, and utilization-based outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional analysis examined commercial claims data from a national health insurance plan. A cohort of eligible beneficiaries with diabetes aged 18 to 65 years who were enrolled for at least 12 months from January 1, 2010, through December 31, 2014, was defined. Eligible beneficiaries were attributed to a clinical practice group based on the plurality of their primary care or endocrinology office visits. Data were analyzed from October 1, 2018, through April 30, 2019. MAIN OUTCOMES AND MEASURES: For each clinical practice group, performance on current diabetes quality measures included 3 process measures (2 testing measures [hemoglobin A(1c) {HbA(1c)} and low-density lipoprotein {LDL} testing] and 1 drug use measure [statin use]) and 2 disease control measures (HbA(1c) <8% and LDL level <100 mg/dL). The rates of utilization-based outcomes, including hospitalization for diabetes and major adverse cardiovascular events (MACEs), were also measured. RESULTS: In this cohort of 652 258 beneficiaries with diabetes from 886 clinical practice groups, 42.9% were aged 51 to 60 years, and 52.6% were men. Beneficiaries lived in areas that were predominantly white (68.1%). At the clinical practice group level, except for high correlation between the 2 testing measures, correlations among different quality measures were weak (r range, 0.010-0.244). Rate of HbA(1c) of less than 8% had the strongest correlation with hospitalization for MACE (r = −0.046; P = .03) and diabetes (r = −0.109; P < .001). Rates of HbA(1c) control at the clinical practice group level were not significantly associated with likelihood of hospitalization at the individual level. Performance on the process and disease control measures together explained 3.9% of the variation in the likelihood of hospitalization for a MACE or diabetes at the individual level. CONCLUSIONS AND RELEVANCE: In this study, performance on utilization-based measures—intended to reflect the quality of chronic disease management—was only weakly associated with direct measures of chronic disease management, namely, disease control measures. This correlation should be considered when determining the degree of financial emphasis to place on hospitalization rates as a measure of quality in treatment of chronic diseases. American Medical Association 2019-08-14 /pmc/articles/PMC6694385/ /pubmed/31411713 http://dx.doi.org/10.1001/jamanetworkopen.2019.9139 Text en Copyright 2019 Gilstrap LG et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Gilstrap, Lauren G.
Chernew, Michael E.
Nguyen, Christina A.
Alam, Sartaj
Bai, Barbara
McWilliams, J. Michael
Landon, Bruce E.
Landrum, Mary Beth
Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title_full Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title_fullStr Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title_full_unstemmed Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title_short Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes
title_sort association between clinical practice group adherence to quality measures and adverse outcomes among adult patients with diabetes
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694385/
https://www.ncbi.nlm.nih.gov/pubmed/31411713
http://dx.doi.org/10.1001/jamanetworkopen.2019.9139
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