Managed Care Organization and the Quality of Diabetes Care
The Translating Research Into Action for Diabetes (TRIAD) study
- Catherine Kim, MD, MPH12,
- David F. Williamson, PHD3,
- Carol M. Mangione, MD, MSPH4,
- Monika M. Safford, MD5,
- Joseph V. Selby, MD, MPH6,
- David G. Marrero, PHD7,
- J. David Curb, MD, MPH8,
- Theodore J. Thompson, MS3,
- K.M. Venkat Narayan, MD, MSC, MBA3,
- William H. Herman, MD, MPH910 and
- the TRIAD Study Group*
- 1Department of Internal Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
- 2Department of Obstetrics & Gynecology, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
- 3Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
- 4Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- 5Department of Internal Medicine, Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
- 6Division of Research, Kaiser Permanente, Oakland, California
- 7Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- 8Pacific Health Research Institute, Honolulu, Hawaii
- 9Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Michigan, Ann Arbor, Michigan
- 10Department 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
Abstract
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 HbA1c 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.
Footnotes
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Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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↵* A list of the members of the Translating Research into Action for Diabetes (TRIAD) Study Group can be found in the online appendix.
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- Accepted March 25, 2004.
- Received February 25, 2003.
- DIABETES CARE
