Provider deferred decisions on hemoglobin A1c results: a report from the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN).
BACKGROUND
Hemoglobin A1c (HbA1c) results are generally reviewed several days after office visits. The clinical decisions on elevated HbA1cs may be complex and are rarely urgent. Providers may elect to defer the decision or its implementation to a future clinical encounter.


OBJECTIVE
To determine the occurrence rate, predictors, and eventual decision outcomes for HbA1c deferred decisions.


METHODS
Provider questionnaire completed when HbA1c results from type 2 diabetes patients were reviewed, followed by a chart review on deferred cases 6 months later.


METHODS
Providers at 19 Colorado primary care clinics.


METHODS
For HbA1c > or =7%, whether the decision or its implementation was deferred. In deferred cases, whether a clinical decision was eventually made.


RESULTS
Of the 311 HbA1cs > or =7%, 31 (10.0%) had deferred decisions. In multivariate analysis, deferred decisions were more likely in African Americans (odds ratio [OR] 4.91, 95% CI 1.81, 13.3) and less likely when the patient's usual provider reviewed the HbA1c (OR 0.40, 95% CI 0.18, 0.90). In the chart review, for deferred cases (n = 18), a clinical decision was made in 14 cases, usually at the next clinical encounter. In 4 cases, the HbA1c was never addressed.


CONCLUSIONS
Deferred decisions on HbA1c results are infrequent, and usually the HbA1c is eventually addressed.
Department of Family Medicine, University of Colorado School of Medicine, Health Sciences Center, 12474 E. 19th Avenue, PO Box 6508, Campus Box F496, Aurora, CO 80045-0508, USA. bennett.parnes@uchsc.edu
Bennett
B
Parnes
Linda
L
Niebauer
Sherry
S
Holcomb
Miriam
M
Dickinson
Jack
J
Westfall
Becky
B
Vanvorst
Wilson
W
Pace
D003120:Colorado; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000175:diagnosis / Q000517:prevention & control*; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D006442:Glycated Hemoglobin / Q000032:analysis*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008485:Medical Audit; D009819:Office Visits; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
D006442:Glycated Hemoglobin