title: Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care.
abstract: To assess the influence of relational climate on quality of diabetes care.
  
  
  
  The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets.
  
  
  
  Multilevel panel data (2008-2012) with patients nested into clinics.
  
  
  
  Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure).
  
  
  
  The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes.
  
  
  
  Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care.
authors.affiliation: Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.|Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.|Health Care Financing and Payment Program (HCFP), RTI International, Waltham, MA.
authors.forename: Marina
authors.initials: M
authors.lastname: Soley-Bori
authors.affiliation: Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.|Department of Veterans Affairs Central Texas Healthcare System, VISN 17 Center of Excellence for Research on Returning Veterans, Waco, TX.|Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Benzer
authors.affiliation: Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.|Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003142:Communication; D003920:Diabetes Mellitus; D005260:Female; D006442:Glycated Hemoglobin; D006126:Group Processes; D006801:Humans; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D012720:Severity of Illness Index; D012737:Sex Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin
keywords: Diabetes; primary care; quality of care; relational climate