Proportion of patients with a clearly indicated visit to a diabetes specialist, by age of patient and physician payment model
| Characteristic | Total, no. (%) n = 11 130 | Fee for service, % (95% CI) n = 9988 | Salary based, % (95% CI) n = 1142 | Comparison of patients seen by salary-based physicians with patients seen by fee-for-service physicians, risk ratio (95% CI) | p value |
|---|---|---|---|---|---|
| All patients | |||||
| Visit with a clear indication to a diabetes specialist* | 6297 (56.6) | 55.6 (54.1–57.1) | 65.2 (60.7–70.1) | 1.17 (1.1–1.3) | < 0.001 |
| Poorly controlled HbA1C† | 4442 (39.9) | 38.8 (37.6–40.0) | 49.9 (46.0–54.2) | 1.29 (1.2–1.4) | < 0.001 |
| Elevated HbA1C and on 3 or more diabetes medications‡ | 970 (8.7) | 9.2 (8.6–9.8) | 4.5 (3.4–5.9) | 0.49 (0.4–0.6) | < 0.001 |
| Elevated HbA1C and on insulin§ | 4058 (36.5) | 35.1 (34.0–36.3) | 48.4 (44.6–52.6) | 1.38 (1.3–1.5) | < 0.001 |
| Hospital or ED visits for a diabetes-specific ACSC in the year before the specialist visit¶ | 162 (1.5) | 1.3 (1.1–1.5) | 3.2 (2.3–4.4) | 2.50 (1.7–3.6) | < 0.001 |
| Age 18–29 yr | n = 906 | n = 610 | n = 296 | ||
| Visit with a clear indication to a diabetes specialist* | 560 (61.8) | 61.0 (55.1–67.5) | 63.5 (55.1–73.3) | 1.04 (0.9–1.2) | 0.7 |
| Poorly controlled HbA1C† | 439 (48.5) | 47.7 (42.5–53.5) | 50.0 (42.6–58.7) | 1.05 (0.9–1.3) | 0.6 |
| Elevated HbA1C and on 3 or more diabetes medications‡ | 3 (0.3) | 0.33 (0.1–1.3) | 0.34 (0.1–2.4) | 1.03 (0.1–11.4) | 1.0 |
| Elevated HbA1C and on insulin§ | 455 (50.2) | 47.9 (42.7–53.7) | 55.1 (47.2–64.2) | 1.15 (1.0–1.4) | 0.2 |
| Hospital or ED visits for a diabetes-specific ACSC in the year before the specialist visit¶ | 22 (2.4) | 2.5 (1.5–4.1) | 2.4 (1.1–5.0) | 0.96 (0.4–2.4) | 0.9 |
| Age > 29 yr | n = 10 224 | n = 9378 | n = 846 | ||
| Visit with a clear indication to a diabetes specialist* | 5737 (56.1) | 55.2 (53.8–56.8) | 65.8 (60.6–71.5) | 1.19 (1.1–1.3) | < 0.001 |
| Poorly controlled HbA1C† | 4003 (39.2) | 38.2 (37.0–39.5) | 49.9 (45.3–54.9) | 1.31 (1.2–1.5) | < 0.001 |
| Elevated HbA1C and on 3 or more diabetes medications‡ | 967 (9.5) | 9.8 (9.2–10.4) | 5.9 (4.5–7.8) | 0.60 (0.5–0.8) | < 0.001 |
| Elevated HbA1C and on insulin§ | 3603 (35.2) | 34.3 (33.1–35.5) | 46.1 (41.7–50.9) | 1.35 (1.2–1.5) | < 0.001 |
| Hospital or ED visits for a diabetes-specific ACSC in the year before the specialist visit¶ | 140 (1.4) | 1.18 (0.98–1.4) | 3.4 (2.4–4.9) | 2.90 (1.9–4.4) | < 0.001 |
Note: ACSC = ambulatory care sensitive condition, CI = confidence interval, ED = emergency department.
↵* Diabetes specialists were defined as those seeing > 50 patients with diabetes each year and for whom > 30% of claims were for outpatient diabetes treatment.
↵† HbA1c > 8.5.
↵‡ HbA1c > 7.5 and taking 3 or more non-insulin antihyperglycemic agents.
↵§ HbA1c > 7.5 and on insulin.
↵¶ Hypoglycemic- or hyperglycemic-related incidents (ICD-10 [International Statistical Classification of Diseases and Related Health Problems, 10th revision] codes E10.0 [type 1 with coma], E10.63 [type 1 with hypoglycemia], E11.0 [type 2 with coma], E11.63 [type 2 with hypoglycemia], E13.0 [other specified with coma], E13.63 [other specified with hypoglycemia], E14.0 [unspecified with coma] and E14.63 [unspecified with hypoglycemia]).