PCP Patient Volume Linked to Diabetes Care Quality
Recent research suggests primary care physicians (PCPs) with busier ambulatory patient practices delivered lower-quality diabetes care; however, PCPs with higher diabetes-specific patient volume delivered higher-quality care.
“Although a relationship between volume and quality has previously been demonstrated with procedural and hospital-based volumes, there has been less research demonstrating associations between outpatient volumes and quality of care in chronic disease management,” Andrew Cheung, MD and colleagues wrote in the study. “Our study provides evidence of such a relationship in the outpatient context.”
To determine the association between PCP volume and quality of diabetes care, researchers conducted a cohort study using linked population-based health care administrative data. They examined 1,018,647 adults with diabetes in 2011 who received care from 9014 PCPs. Researchers focused on two measures of volume ascertained for each physician, including overall ambulatory volume and diabetes-specific volume.
Researchers measured quality of care over a two-year period using six indicators:
- disease monitoring, including eye examination, hemoglobin A1c testing, and low-density lipoprotein cholesterol testing;
- prescription of appropriate medications, including angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers and statins; and,
- and adverse clinical outcomes—including emergency department visits for hypoglycemia or hyperglycemia.
The researchers determined that higher ambulatory volume was connected with lower rates of appropriate disease monitoring and medication prescription. Comparatively, higher diabetes-specific volume was connected with better quality of care across all six indicators.
“The question remains of how many patients with and without diabetes should be empaneled with a PCP so that the dual goals of comprehensive, evidence-based primary care, and a manageable physician workday can be achieved.” Dr Chang concluded.
—Julie Mazurkiewicz
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