title: Quality of preventive care for diabetes: effects of visit frequency and competing demands.
abstract: OBJECTIVE
  We sought to determine the association between timely receipt of diabetes-related preventive services and the longitudinal pattern of outpatient service use as characterized by a novel taxonomy that prioritized visits based on the Oregon State Prioritized Health Services List.
  
  
  METHODS
  We performed a cross-sectional analysis of mail survey and automated health care data for a population-based sample of patients with diabetes enrolled in a health maintenance organization in Washington State (N = 4,463). Outcomes included American Diabetes Association-recommended preventive services, including regular hemoglobin A1C (HbA1C) monitoring, retinal examination, and microalbuminuria screening. Patients with fewer than 8 visits during the 2-year study period were considered infrequent users, while patients with 8 or more visits were classified as lower-priority users if most visits were for conditions of relatively low rank on the Oregon list and as higher-priority users otherwise.
  
  
  RESULTS
  After adjustment for social, demographic, and clinical factors, and depression, infrequent users had significantly reduced odds of receiving at least 1 HbA1C test (odds ratio [OR] = 0.35, 95% confidence interval [CI], 0.24-0.51), retinal examination (OR = 0.74, 95% CI, 0.63-0.86), and microalbuminuria screening (OR = 0.75, 95% CI, 0.58-0.96) relative to higher-priority users during the previous year. Lower-priority users also had relatively reduced odds of receiving at least 1 HbA(1C) test (OR = 0.59, 95% CI, 0.35-1.01), retinal examination (OR = 0.68, 95% CI, 0.56-0.84), and microalbuminuria screening (OR = 0.79, 95% CI, 0.57-1.09) despite attending a similar mean number of total visits as higher-priority users.
  
  
  CONCLUSIONS
  Patients who attend relatively few outpatient visits or who attend more frequent visits for predominantly lower-priority conditions are more likely to receive substandard preventive care for diabetes.
authors.affiliation: Department of Family and Community Medicine, University of California, Davis, Sacramento, Calif 95817, USA. joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006279:Health Maintenance Organizations; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012307:Risk Factors; D014861:Washington
chemical_list: D006442:Glycated Hemoglobin