Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry.
| Autor: | Essien UR; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA., Tang Y; Saint Luke's Mid America Heart Institute, Kansas City, MO., Figueroa JF; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA., Litam TMA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA., Tang F; Saint Luke's Mid America Heart Institute, Kansas City, MO., Jones PG; Saint Luke's Mid America Heart Institute, Kansas City, MO., Patel R; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL., Wadhera RK; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA., Desai NR; Section of Cardiovascular Medicine and the Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT., Mehta SN; Clinical, Behavioral, and Outcomes Research Section, Joslin Diabetes Center, Boston, MA., Kosiborod MN; Saint Luke's Mid America Heart Institute, Kansas City, MO., Vaduganathan M; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. |
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| Jazyk: | angličtina |
| Zdroj: | Diabetes care [Diabetes Care] 2022 Jul 07; Vol. 45 (7), pp. 1549-1557. |
| DOI: | 10.2337/dc21-1178 |
| Abstrakt: | Objective: Medicare Advantage (MA), Medicare's managed care program, is quickly expanding, yet little is known about diabetes care quality delivered under MA compared with traditional fee-for-service (FFS) Medicare. Research Design and Methods: This was a retrospective cohort study of Medicare beneficiaries ≥65 years old enrolled in the Diabetes Collaborative Registry from 2014 to 2019 with type 2 diabetes treated with one or more antihyperglycemic therapies. Quality measures, cardiometabolic risk factor control, and antihyperglycemic prescription patterns were compared between Medicare plan groups, adjusted for sociodemographic and clinical factors. Results: Among 345,911 Medicare beneficiaries, 229,598 (66%) were enrolled in FFS and 116,313 (34%) in MA plans (for ≥1 month). MA beneficiaries were more likely to receive ACE inhibitors/angiotensin receptor blockers for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care, and kidney disease (adjusted P ≤ 0.001 for all). MA beneficiaries had modestly but significantly higher systolic blood pressure (+0.2 mmHg), LDL cholesterol (+2.6 mg/dL), and HbA1c (+0.1%) (adjusted P < 0.01 for all). MA beneficiaries were independently less likely to receive glucagon-like peptide 1 receptor agonists (6.9% vs. 9.0%; adjusted odds ratio 0.80, 95% CI 0.77-0.84) and sodium-glucose cotransporter 2 inhibitors (5.4% vs. 6.7%; adjusted odds ratio 0.91, 95% CI 0.87-0.95). When integrating Centers for Medicare and Medicaid Services-linked data from 2014 to 2017 and more recent unlinked data from the Diabetes Collaborative Registry through 2019 (total N = 411,465), these therapeutic differences persisted, including among subgroups with established cardiovascular and kidney disease. Conclusions: While MA plans enable greater access to preventive care, this may not translate to improved intermediate health outcomes. MA beneficiaries are also less likely to receive newer antihyperglycemic therapies with proven outcome benefits in high-risk individuals. Long-term health outcomes under various Medicare plans requires surveillance. (© 2022 by the American Diabetes Association.) |
| Databáze: | MEDLINE |
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