title: Effects of patient volume on quality of outpatient diabetes care.
abstract: In this study we aimed to evaluate the effects of practice size (patient volume) and diabetes caseload in outpatient services on the quality of diabetes care in a teaching hospital. We analyzed the medical records of 2038 diabetic patients treated at a medical center in central Taiwan between January and June 2007. Outpatient practice size (including diabetic and non-diabetic patients) per clinic decreased the odds of glycated hemoglobin (A1C) testing (13% less for every 10 increase in outpatient encounters; p<0.001), and the percentage of A1C values<7% (8% less for every 10 increase in outpatient encounters; p=0.03) in diabetic patients treated by non-endocrinologists. However, a higher caseload of patients with diabetes was associated with an increased lipid profile measurement (19% more for every 5 increase in diabetic patients; p<0.001). In diabetic patients treated by endocrinologists, a higher patient volume was associated with increased odds of low-density-lipoprotein cholesterol (LDL-C) levels<100mg/dl, although there was no effect on the measurement and values of A1C. In conclusion, our study demonstrated some evidence of patient volume-outcome relationship in the management of diabetes in different specialties. This finding can have some implications to the health care system and the referral policy.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Jun-Sing
authors.initials: JS
authors.lastname: Wang
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.forename: Wayne H-H
authors.initials: WH
authors.lastname: Sheu
authors.forename: I-Te
authors.initials: IT
authors.lastname: Lee
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Tseng
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Song
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D008078:Cholesterol, LDL / Q000097:blood; D003695:Delivery of Health Care / Q000592:standards; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008511:Medicine; D010045:Outpatients / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D013038:Specialization; D013624:Taiwan
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin