Treatment approaches and costs associated with diabetes clinical metrics as measured by Healthcare Effectiveness Data and Information Set (HEDIS)

Autor: Jamil Alkhaddo, Jillian M. Rung, Ameer Khowaja, Yue Yin, Shannon B. Richards, Charlotte Drury-Gworek, Samina Afreen, Caitlan Rossi, Susan Manzi
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: BMC Health Services Research, Vol 24, Iss 1, Pp 1-10 (2024)
Druh dokumentu: article
ISSN: 1472-6963
DOI: 10.1186/s12913-024-10745-2
Popis: Abstract Background The clinical outcomes of diabetes can be influenced by primary care providers’ (PCP) treatment approaches. This study explores the association between PCP approaches to management and performance measured by established diabetes metrics and related costs. Methods In phase one, Electronic Medical Records were used to extract diabetes related metrics using Healthcare Effectiveness Data and Information Set (HEDIS), for patients with diabetes who had office visits to 44 PCP practices from April 2019 to March 2020. Using those metrics and scoring system, PCP practices were ranked and then categorized into high- and low-performing groups (top and bottom 25%, n = 11 each), with a total of 19,059 clinic visits by patients with a diagnosis of diabetes. Then extensive analysis was performed to evaluate a correlation between treatment approaches and diabetes outcomes across the top and bottom performing practices. In phase 2, patients with diabetes who were attributed to the aforementioned PCP practices were identified in a local health plan claims data base (a total of 3,221 patients), and the allowed amounts from their claims were used to evaluate differences in total and diabetes-related healthcare costs by providers’ performance. Results Comparing 10,834 visits in high-performing practices to 8,235 visits in low-performing practices, referrals to certified diabetes care and education specialists and provider-to-provider electronic consults (e-consults) were higher in high-performing practices (Z = 6.06, p
Databáze: Directory of Open Access Journals
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