Risk and protective factors associated with screening for complications of diabetes in a health maintenance organization setting.
OBJECTIVE
To identify risk and protective factors associated with screening for complications of diabetes, we performed a cross-sectional study of 3,612 diabetic members enrolled in CaliforniaCare, a large network-model health maintenance organization (HMO).


METHODS
We used the Health Plan and Employer Data Information Set (HEDIS) 3.0 technical definition to identify all members (aged > or = 31 years) receiving any diabetes medication(s) during a 12-month period. Using a telephone survey instrument, identified members were interviewed about their diabetes care and screening, patient, and provider history. Survey data were supplemented with HMO claims and demographic information. Multivariate analysis was performed to identify demographic, clinical, and utilization characteristics that affect the odds of diabetic members receiving annual retinal examination, foot examination, and HbA1c testing.


RESULTS
While results varied by screening category, the odds of obtaining screening were higher for diabetic members who were older, spoke English, received diabetes nutrition counseling, visited a diabetes specialist physician, belonged to a diabetes association or support group, used insulin, performed glycemic level self-examination at least once a day, and had higher overall prescription drug use (suggesting higher comorbidity). Since this study is a cross-sectional review, these results do not imply a cause-and-effect relationship between dependent and independent variables.


CONCLUSIONS
Results of this study suggest barriers, risks, and protective factors associated with screening for complications of diabetes. Diabetic members who do not possess these characteristics may be at increased risk.
Simon
L P
LP
Blue Cross of California, Woodland Hills 91367, USA.
Albright
A
A
Belman
M J
MJ
Tom
E
E
Rideout
J A
JA
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002140:California; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic; D012307:Risk Factors
D001786:Blood Glucose