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The Oregon Health Plan

Predictors of office-based diabetic quality of care

From the Departments of Medicine (M.S.) and Pediatrics (N.S.) and the Bowen Research Center (M.P.), Indiana University School of Medicine; and the Regenstrief Institute (M.S.), Indianapolis, Indiana.

Address correspondence and reprint requests to Malathi Srinivasan, MD, Department of Medicine, 1050 Wishard Blvd., Sixth Floor, Indianapolis, IN 46202. E-mail: msriniva{at}iupui.edu .

OBJECTIVE— In 1994, the Oregon Health Plan (OHP) expanded basic Medicaid insurance to residents under the federal poverty limit, adopted a prioritized limited benefits package, and converted to managed care. The quality of care in predominantly Medicaid populations with diabetes has not been previously described. In OHP enrollees, we examined predictors of diabetes care based on American Diabetes Association guidelines and described OHP diabetes care compared with national benchmarks.

RESEARCH DESIGN AND METHODS— Chart abstraction and Medicaid data for 1995-1996 yielded 996 nonpregnant diabetic patients who were 18-64 years of age. Using HbA_lc, lipid panel, and urine protein/microalbumin documentation ordered during the study year, we constructed a standard care (SC) index: SC for all three tests, mixed care (MC) for one to two tests, or no tests documented (NTD).

RESULTS— Our sample was predominantly white, 48 ± 11 years of age, 63% women, with 8 ± 5 provider visits. Providers ordered HbA_lc (70%), urine microalbumin/protein (57%), and lipid panel (41%) tests. Patients distributed into SC (22%), MC (62%), or NTD (16%). Thirteen variables predicted SC. Patients had a higher likelihood of SC if they were 18-24 years of age, had more clinic visits, were on insulin daily, were in several comorbid groups, were enrolled in salaried or capitated health plans, or lived in counties with more hospital beds. Four studies were used as comparable national benchmarks.

CONCLUSIONS— Care provided to OHP patients with diabetes compares favorably with national benchmarks. Yet, most OHP patients with diabetes are still not achieving optimal care. Examining predictors of SC may play an important role in further policy development.

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