The association between payment model and specialist physicians’ selection of patients with diabetes: a descriptive study

Note: ACSC = ambulatory care sensitive condition, CKD = chronic kidney disease, ED = emergency department, SD = standard deviation.

↵* Primary care attachment (also called relational continuity) categories are defined as infrequent (1 or 2 primary care visits), high (> 75% of patients’ 3 or more primary care visits made to the same physician), medium (50%–75% of 3 or more visits made to the same physician), and low (< 50% of visits made to any 1 primary care physician).

↵† Diabetes-specific ambulatory care sensitive conditions include coma, acidosis and hypoglycemia and no mention of complications for type 1, type 2, other specified and unspecified diabetes.

↵‡ More advanced CKD is defined as estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m², eGFR < 45 mL/min/1.73 m² with moderate or severe albuminuria, or eGFR < 60 mL/min/1.73 m² with severe albuminuria. Moderate albuminuria is defined as albumin-creatinine ratio (ACR) 30–300 mg/g, protein-creatinine ratio (PCR) 150–500 mg/g, urine dipstick (UDIP) 1+ and severe albuminuria is defined as ACR > 300 mg/g, PCR > 500 mg/g, UDIP ≥ 2+.

↵§ Comorbidities included diabetes, CKD and 28 other chronic conditions with validated administrative data algorithms.20

Note: SD = standard deviation.

↵* Diabetes specialists are endocrinologists and internal medicine physicians who see > 50 patients with diabetes each year and for whom > 30% of claims are for outpatient diabetes care.

↵† Clinical workload is defined as the following: tertile 1 = fewer than 94 days billing per year, tertile 2 = 95–221 days billing per year, tertile 3 = 222–365 days billing per year.

↵‡ The province of Alberta has 2 large urban areas: the cities of Calgary and Edmonton.

↵§ Includes patient home visits and missing clinic locations.