TY - JOUR
T1 - Disparities in diabetes care
T2 - Differences between rural and urban patients within a large health system
AU - Foss, Randy
AU - Fischer, Karen
AU - Lampman, Michelle A.
AU - Laabs, Susan
AU - Halasy, Michael
AU - Allen, Summer V.
AU - Garrison, Gregory M.
AU - Sobolik, Gerald
AU - Bernard, Matthew
AU - Sosso, Jessica
AU - Thacher, Tom D.
N1 - Publisher Copyright:
© 2023, Annals of Family Medicine, Inc. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - PURPOSE We sought to ascertain factors associated with the quality of diabetes care, comparing rural vs urban diabetic patients in a large health care system. METHODS We conducted a retrospective cohort study assessing patients’ attainment of the D5 metric, a diabetes care metric having 5 components (no tobacco use, glycated hemoglobin [A1c] level less than 8%, blood pressure less than 140/90 mm Hg, low-density lipoprotein cholesterol level at goal or statin prescribed, and aspirin use consistent with clinical recommendations). Covariates included age, sex, race, adjusted clinical group (ACG) score as a marker of complexity, insurance type, primary care clinician type, and health care use data. RESULTS The study cohort consisted of 45,279 patients with diabetes, 54.4% of whom resided in rural locations. The D5 composite metric was met in 39.9% of rural patients and 43.2% of urban patients (P <.001). Rural patients were significantly less likely to have attained all metric goals than urban counterparts (adjusted odds ratio [AOR] = 0.93; 95% CI, 0.88-0.97). The rural group had fewer outpatient visits (mean number of visits = 3.2 vs 3.9, P <.001) and less often had an endocrinology visit (5.5% vs 9.3%, P <.001) during the 1-year study period. Patients with an endocrinology visit were less likely to have met the D5 metric (AOR = 0.80; 95% CI, 0.73-0.86), whereas the more outpatient visits patients had, the greater their likelihood of attainment (AOR per visit = 1.03; 95% CI, 1.03-1.04). CONCLUSIONS Rural patients had worse diabetes quality outcomes than their urban counterparts, even after adjustment for other contributing factors and despite being part of the same integrated health system. Lower visit frequency and less specialty involvement in the rural setting are possible contributing factors.
AB - PURPOSE We sought to ascertain factors associated with the quality of diabetes care, comparing rural vs urban diabetic patients in a large health care system. METHODS We conducted a retrospective cohort study assessing patients’ attainment of the D5 metric, a diabetes care metric having 5 components (no tobacco use, glycated hemoglobin [A1c] level less than 8%, blood pressure less than 140/90 mm Hg, low-density lipoprotein cholesterol level at goal or statin prescribed, and aspirin use consistent with clinical recommendations). Covariates included age, sex, race, adjusted clinical group (ACG) score as a marker of complexity, insurance type, primary care clinician type, and health care use data. RESULTS The study cohort consisted of 45,279 patients with diabetes, 54.4% of whom resided in rural locations. The D5 composite metric was met in 39.9% of rural patients and 43.2% of urban patients (P <.001). Rural patients were significantly less likely to have attained all metric goals than urban counterparts (adjusted odds ratio [AOR] = 0.93; 95% CI, 0.88-0.97). The rural group had fewer outpatient visits (mean number of visits = 3.2 vs 3.9, P <.001) and less often had an endocrinology visit (5.5% vs 9.3%, P <.001) during the 1-year study period. Patients with an endocrinology visit were less likely to have met the D5 metric (AOR = 0.80; 95% CI, 0.73-0.86), whereas the more outpatient visits patients had, the greater their likelihood of attainment (AOR per visit = 1.03; 95% CI, 1.03-1.04). CONCLUSIONS Rural patients had worse diabetes quality outcomes than their urban counterparts, even after adjustment for other contributing factors and despite being part of the same integrated health system. Lower visit frequency and less specialty involvement in the rural setting are possible contributing factors.
KW - Diabetes control
KW - Health care delivery
KW - Health care disparities
KW - Health metrics
KW - Health services
KW - Health services accessibility
KW - Population health
KW - Primary care
KW - Quality of care
KW - Rural health
KW - Rural health disparities
KW - Vulnerable populations
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U2 - 10.1370/afm.2962
DO - 10.1370/afm.2962
M3 - Article
C2 - 37217319
AN - SCOPUS:85159827172
SN - 1544-1709
VL - 21
SP - 234
EP - 239
JO - Annals of family medicine
JF - Annals of family medicine
IS - 3
ER -