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Managed Care Organization and the Quality of Diabetes Care

The Translating Research Into Action for Diabetes (TRIAD) study

¹ Department of Internal Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
² Department of Obstetrics & Gynecology, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
³ Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
⁴ Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
⁵ Department of Internal Medicine, Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
⁶ Division of Research, Kaiser Permanente, Oakland, California
⁷ Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
⁸ Pacific Health Research Institute, Honolulu, Hawaii
⁹ Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Michigan, Ann Arbor, Michigan
¹⁰ Department of Epidemiology, University of Michigan, Ann Arbor, Michigan

Address correspondence and reprint requests to Catherine Kim, MD, MPH, 300 North Ingalls Building, Room 7C13, Ann Arbor, MI 48109. E-mail: cathkim{at}umich.edu

OBJECTIVE—To examine the association between the organizational model and diabetes processes of care.

RESEARCH DESIGN AND METHODS—We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8,354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA_1c testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language.

RESULTS—Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P < 0.0001), and group/network models generally increased the probability of receiving a process by 10 percentage points. Among nonprofit plans, no effect of model type was found.

CONCLUSIONS—Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.

Abbreviations: IPA, independent practice association • TRIAD, Translating Research into Action for Diabetes

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