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1 Health Services Research, Christiana Care Health Services, Wilmington, Del
2 Medical University of South Carolina, Charleston, SC
3 Jefferson Medical College, Philadelphia, Pa
4 Christiana Care Health Services, Wilmington, Del
CORRESPONDING AUTHOR James M. Gill, MD, MPH Christiana Care Health System 1401 Foulk Rd Wilmington, DE 19803 jgill{at}christianacare.org
BACKGROUND Many patients with diabetes fail to receive recommended monitoring tests. One reason might be inadequate continuity of care. This study examined the association between provider continuity and completion of monitoring tests for patients with diabetes mellitus.
METHODS A cross-sectional analysis was conducted on claims data from a private national health plan for 1 year (January 1,1999, through December 31,1999). Participants had a diagnosis of diabetes mellitus and at least 2 outpatient visits during the study year (N = 1,795). The association was measured between continuity of care with an individual provider and completion of 3 diabetes monitoring tests: a glycosylated hemoglobin test, a lipid profile, and an eye examination.
RESULTS Eighty-one percent of patients had a glycosylated hemoglobin test, 66% had a lipid profile, and 28% had an eye examination during the study year. After controlling for demographics, number of diabetes visits, case mix, and diabetes complications, provider continuity was not significantly associated with the receipt of a glycosylated hemoglobin test (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.32-1.16), a lipid profile (OR = 0.97, 95% CI, 0.57-1.64) or an eye examination (OR = 0.60, 95% CI, 0.30-1.19). When continuity was measured only among primary care providers, there was no significant association for receipt of a glycosylated hemoglobin test (OR = 0.73, 95% CI, 0.41-1.33), a lipid profile (OR = 0.88, 95% CI, 0.53-1.47) or an eye examination (OR = 0.70, 95% CI, 0.35-1.36).
CONCLUSIONS This study found no association between provider continuity and completion of diabetes monitoring tests in a national privately insured population. Whereas continuity might benefit other aspects of health care, it does not appear to benefit improved monitoring for diabetes.
Key Words: Continuity of patient care • primary health care • quality of health care • diabetes mellitus
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