Table 5

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

Hemoglobin A1c TestLDL ScreeningNephropathy ScreeningEye ExamSummary Score
OR (95% CI)P ValueOR (95% CI)P ValueOR (95% CI)P ValueOR (95% CI)P ValueOR (95% CI)P Value
Sponsoring Institution Characteristics
 Percent of graduates in rural practice0.98 (0.31–3.04).970.53 (0.19–1.42).200.58 (0.23–1.49).260.91 (0.67–1.24).560.88 (0.67–1.16).35
 Percent of graduates in primary care1.10 (0.58–2.08).761.57 (0.85–2.91).151.43 (0.76–2.68).270.94 (0.75–1.19).621.08 (0.93–1.26).32
 Sponsoring institution size, natural log1.09 (0.98–1.22).121.10 (0.99–1.23).081.12 (1.00–1.25).061.00 (0.96–1.04).921.03 (1.00–1.05).05
Training HSA spending categorya
 LowReferenceReferenceReferenceReferenceReference
 Average0.98 (0.76–1.25).851.06 (0.85–1.33).591.04 (0.85–1.26).730.95 (0.88–1.02).141.00 (0.95–1.06).95
 High1.06 (0.082–1.38).651.14 (0.91–1.44).261.09 (0.89–1.34).401.01 (0.93–1.09).841.03 (0.97–1.09).38
Practice HSA spending category
 Low ($6,102 to $8,683)ReferenceReferenceReferenceReferenceReference
 Average ($8,691 to $9,879)1.34 (1.03–1.73).031.23 (0.98–1.55).071.12 (0.90–1.39).300.95 (0.88–1.03).231.06 (0.99–1.12).08
 High ($9,880 to $16,542)1.27 (1.00–1.60).051.38 (1.12–1.71).003.88 (0.70–1.09).240.88 (0.81–0.96).0031.03 (0.97–1.09).29
CovariatesbYesYesYesYesYes
  • 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.