Impact of provider continuity on quality of care for persons with diabetes mellitus.
BACKGROUND
Many patients with diabetes fail to receive recommended monitoring tests. One reason might be inadequate continuity of care. This study examined the association between provider continuity and completion of monitoring tests for patients with diabetes mellitus.


METHODS
A cross-sectional analysis was conducted on claims data from a private national health plan for 1 year (January 1, 1999, through December 31, 1999). Participants had a diagnosis of diabetes mellitus and at least 2 outpatient visits during the study year (N = 1,795). The association was measured between continuity of care with an individual provider and completion of 3 diabetes monitoring tests: a glycosylated hemoglobin test, a lipid profile, and an eye examination.


RESULTS
Eighty-one percent of patients had a glycosylated hemoglobin test, 66% had a lipid profile, and 28% had an eye examination during the study year. After controlling for demographics, number of diabetes visits, case mix, and diabetes complications, provider continuity was not significantly associated with the receipt of a glycosylated hemoglobin test (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.32-1.16), a lipid profile (OR = 0.97, 95% CI, 0.57-1.64) or an eye examination (OR = 0.60, 95% CI, 0.30-1.19). When continuity was measured only among primary care providers, there was no significant association for receipt of a glycosylated hemoglobin test (OR = 0.73, 95% CI, 0.41-1.33), a lipid profile (OR = 0.88, 95% CI, 0.53-1.47) or an eye examination (OR = 0.70, 95% CI, 0.35-1.36).


CONCLUSIONS
This study found no association between provider continuity and completion of diabetes monitoring tests in a national privately insured population. Whereas continuity might benefit other aspects of health care, it does not appear to benefit improved monitoring for diabetes.
Gill
James M
JM
Health Services Research, Christiana Care Health Services, Wilmington, Del 19803, USA. jgill@christianacare.org
Mainous
Arch G
AG
Diamond
James J
JJ
Lenhard
M James
MJ
D000328:Adult; D003266:Continuity of Patient Care / Q000592:standards*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007357:Insurance, Physician Services / Q000592:standards* / Q000706:statistics & numerical data; D008074:Lipoproteins / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018802:Patient-Centered Care / Q000592:standards; D010817:Physician-Patient Relations; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States
D006442:Glycated Hemoglobin; D008074:Lipoproteins