Table 5

Association Between Sponsoring Institution Characteristics, Training HSA Spending category, and Quality Measures for Diabetic Patients

	Hemoglobin A_1c Test		LDL Screening		Nephropathy Screening		Eye Exam		Summary Score

	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value

Sponsoring Institution Characteristics
Percent of graduates in rural practice	0.98 (0.31–3.04)	.97	0.53 (0.19–1.42)	.20	0.58 (0.23–1.49)	.26	0.91 (0.67–1.24)	.56	0.88 (0.67–1.16)	.35
Percent of graduates in primary care	1.10 (0.58–2.08)	.76	1.57 (0.85–2.91)	.15	1.43 (0.76–2.68)	.27	0.94 (0.75–1.19)	.62	1.08 (0.93–1.26)	.32
Sponsoring institution size, natural log	1.09 (0.98–1.22)	.12	1.10 (0.99–1.23)	.08	1.12 (1.00–1.25)	.06	1.00 (0.96–1.04)	.92	1.03 (1.00–1.05)	.05
Training HSA spending category^a
Low	Reference		Reference		Reference		Reference		Reference
Average	0.98 (0.76–1.25)	.85	1.06 (0.85–1.33)	.59	1.04 (0.85–1.26)	.73	0.95 (0.88–1.02)	.14	1.00 (0.95–1.06)	.95
High	1.06 (0.082–1.38)	.65	1.14 (0.91–1.44)	.26	1.09 (0.89–1.34)	.40	1.01 (0.93–1.09)	.84	1.03 (0.97–1.09)	.38
Practice HSA spending category
Low ($6,102 to $8,683)	Reference		Reference		Reference		Reference		Reference
Average ($8,691 to $9,879)	1.34 (1.03–1.73)	.03	1.23 (0.98–1.55)	.07	1.12 (0.90–1.39)	.30	0.95 (0.88–1.03)	.23	1.06 (0.99–1.12)	.08
High ($9,880 to $16,542)	1.27 (1.00–1.60)	.05	1.38 (1.12–1.71)	.003	.88 (0.70–1.09)	.24	0.88 (0.81–0.96)	.003	1.03 (0.97–1.09)	.29
Covariates^b	Yes		Yes		Yes		Yes		Yes

HSA = hospital service area; LDL = low-density lipoprotein.
Note: Data are based on 2011 Medicare Claims. Data are weighted and restricted to primary care physicians with 1–19 years of practice and 40 or more Medicare patients, excluding patients with total expenditures greater than $100,000. For all models, the diabetic beneficiary sample size is 126,666, and the physician sample size is 3,073.
↵a To standardize training HSA spending, we calculated a standardized z score for HSA spending for each year between 1992 and 2010. The training HSA spending groups are Low: −1.49 to −0.14; Average: −0.13 to 0.46; High: 0.48 – 4.50. Each group has approximately the same number of beneficiaries.
↵b See text for list of covariates.