Do diabetes group visits lead to lower medical care charges?
OBJECTIVE
To evaluate whether attending diabetes group visits (GVs) leads to lower medical care charges for inadequately insured patients with type 2 diabetes mellitus (DM).


METHODS
Randomized controlled clinical trial.


METHODS
Data were abstracted from financial records for 186 patients with uncontrolled type 2 DM randomized to receive care in GVs or usual care for 12 months. Mann-Whitney tests for differences of means for outpatient visits (primary and specialty care), emergency department (ED) visits, and inpatient stays were performed. Separate charge models were developed for primary and specialty outpatient visits. Because GV adherence is potentially dependent on unobserved patient characteristics, treatment effect models of outpatient charges and specialty care visits were estimated using maximum likelihood methods.


RESULTS
Mann-Whitney test results indicated that GV patients had reduced ED and total charges but more outpatient charges than usual care patients. Ordinary least squares estimations confirmed that GVs increased outpatient visit charges; however, controlling for endogeneity by estimating a treatment effect model of outpatient visit charges showed that GVs statistically significantly reduced outpatient charges (P <.001). Estimation of a separate treatment effect model of specialty care visits confirmed that GV effects on outpatient visit charges occurred via a reduction in specialty care visits.


CONCLUSIONS
After controlling for endogeneity via estimation of a treatment effect model, GVs statistically significantly reduced outpatient visit charges. Estimation of a separate treatment effect model of specialty care visits indicated that GVs likely substitute for more expensive specialty care visits.
Clancy
Dawn E
DE
Maybank Internal Medicine [corrected], USA. dr_c_maybank_im@bellsouth.net
Dismuke
Clara E
CE
Magruder
Kathryn Marley
KM
Simpson
Kit N
KN
Bradford
David
D
D000328:Adult; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006126:Group Processes; D006297:Health Services Accessibility; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured; D006278:Medicare / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D015397:Program Evaluation; D013022:South Carolina; D018709:Statistics, Nonparametric; D014481:United States