Continuity in diabetes provider improves outcomes and decreases costs

Feb 24th – A sustained relationship with a primary care provider improves outcomes and reduces costs for a large cohort of Korean type II diabetes patients.

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Image: CC/LProfil. Diabetes Prevalence (Orange=highest)

1. Using the same physician for all ambulatory care was linked to improved outcomes in newly diagnosed type II diabetes patients.

2. Continuity of ambulatory care was also linked with decreased medical expenditures. 

This policy study retrospectively analyzes the medical claims of 68,469 newly diagnosed type II diabetes mellitus patients over a four year period of time. Researchers used the Continuity of Care Index (COCI) to evaluate the medical utilization patterns of the patients and associated this value with both clinical outcomes and medical expenditures. The COCI index is a scale from 0 – 1, where a value of 1 indicates a patient who uses the same physician for all their ambulatory care.

Based on these statistical analyses the researchers found that patients with a higher COCI value (close to 1.0) were significantly less associated with co-morbidities, hospitalizations, and mortality. Furthermore, these patients also had lower medical expenses over the course of the study, requiring less care. This study reinforces the wealth of research identifying the value of care continuity in supporting patients with chronic conditions. However, because the study uses insurance claims data (ICD-10 Codes), the researchers are unable to identify demographic variables associated with individual patients or physicians. Variables such as age, sex, socio-economic status, and whether or not patients were managed and educated by diabetes educators were not included in this study.

Click to read the study in Health Policy

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Image: CC/LProfil. Diabetes Prevalence (Orange=highest)

1. Using the same physician for all ambulatory care was linked to improved outcomes in newly diagnosed type II diabetes patients.

2. Continuity of ambulatory care was also linked with decreased medical expenditures.

This [retrospective cohort] study draws on significant research investigating the idea that continuity of care can significantly improve patient outcomes, prevent hospitalizations, and reduce healthcare costs. The researchers retrospectively analyzed medical claims of 68,469 newly diagnosed type II diabetes patients over a four year period of time (2004-2008). After calculating the COCI value for each patient, the claims of that patient were evaluated based on outcomes and financial expenditures to determine whether going to see the same physician over a four year period of time has a significant clinical and financial impact. The COCI value was analyzed along with medical claims data in a multiple regression analysis to identify correlations. The results revealed a significant reduction in medical expenditures as well as an improvement in clinical outcomes. Researchers looked specifically for medical claims associated with hospitalizations, renal or cardiac co-morbidities, and mortality to determine whether the COCI had a positive or negative effect on clinical outcomes and they used the total cost of all procedures, treatments, and medications to determine the overall cost.

In sum: These data provide further support for the patient centered medical home model that places a primary care provider at the center of a patient’s care network. In the medical home model the provider is able to coordinate the care of the patient and facilitate specialty care as required. This study offers a large scale analysis of a diverse population to evaluate the effects of provider continuity. Based on the financial results produced by this study, policies that support continuity of care are projected to create significant value by reducing the cost of medical expenditures. This will continue to be a major issue for the Medicare and Medicaid programs in the United States as they grow under new Affordable Care Act policies and demographic changes.

However, this study is unable to stratify physicians to isolate the physicians with the best outcomes or identify factors such as education level of patient, whether the patient was trained by a diabetes educator, whether there was a case manager to work closely with the patient, or the socio-economic level of the patient. Social and educational data, in addition to the medical claims, would provide further visibility into what variables, in addition to continuity, are improving outcomes while reducing cost.

Click to read the study in Health Policy

By Jordan Anderson and Andrew Bishara

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