title: Revisit frequency and its association with quality of care among diabetic patients: Translating Research Into Action for Diabetes (TRIAD).
abstract: OBJECTIVE
  To describe patient and provider characteristics associated with outpatient revisit frequency and to examine the associations between the revisit frequency and the processes and intermediate outcomes of diabetes care.
  
  
  METHODS
  We analyzed data from Translating Research Into Action for Diabetes (TRIAD), a prospective, multicenter, observational study of diabetes care in managed care.
  
  
  RESULTS
  Our analysis included 6040 eligible adult participants with type 2 diabetes (42.6% ≥65 years of age, 54.1% female) whose primary care providers were the main provider of the participants' diabetes care. The median (interquartile range) revisit frequency was 4.0 (3.7, 6.0) visits per year. Being female, having lower education, lower income, more complex diabetes treatment, cardiovascular disease, higher Charlson comorbidity index, and impaired mobility were associated with higher revisit frequency. The proportion of participants who had annual assessments of HbA1c and LDL-cholesterol, foot examinations, advised or documented aspirin use, and influenza immunizations were higher for those with higher revisit frequency. The proportion of participants who met HbA1c (<9.5%) and LDL-cholesterol (<130 mg/dL) treatment goals were higher for those with a higher revisit frequency. The predicted probabilities of achieving more aggressive goals, HbA1c <8.5%, LDL-cholesterol <100mg/dL, and blood pressure <130/85 or even <140/90 mmHg were not associated with higher revisit frequency.
  
  
  CONCLUSIONS
  Revisit frequency was highly variable and was associated with both sociodemographic characteristics and disease severity. A higher revisit frequency was associated with better processes of diabetes care, but the association with intermediate outcomes was less clear.
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan. Electronic address: kasao@uthsc.edu.
authors.forename: Keiko
authors.initials: K
authors.lastname: Asao
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
authors.forename: Laura N
authors.initials: LN
authors.lastname: McEwen
authors.affiliation: Mathematica Policy Research, Princeton, New Jersey.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.affiliation: Kaiser Permanente Center for Health Research, Honolulu, Hawaii.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D057170:Translational Research, Biomedical; D016896:Treatment Outcome
keywords: Chronic disease management; Outpatient; Primary care; Quality of care; Revisit frequency; Utilization