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Relationship of Physician Volume With Process Measures and Outcomes in Diabetes

  1. Alexander Turchin, MD, MS123,
  2. Maria Shubina, SCD4 and
  3. Merri L. Pendergrass, MD, PHD13
  1. 1Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts
  2. 2Clinical Informatics Research and Development, Partners Healthcare System, Boston, Massachusetts
  3. 3Harvard Medical School, Boston, Massachusetts
  4. 4Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
  1. Address correspondence and reprint requests to Alexander Turchin, MD, MS, Division of Endocrinology, BrighamWomen's Hospital, 221 Longwood Ave., Boston, MA 02115. E-mail: aturchin{at}partners.org

Abstract

OBJECTIVE—The volume of patients cared for by an individual physician (physician volume) has been linked to improved outcomes for a number of conditions. It is not known whether a similar association exists for treatment of diabetes. In this study we aimed to determine whether physician volume is associated with improved process measures and outcomes in diabetes care.

RESEARCH DESIGN AND METHODS—This retrospective cohort study analyzed electronic medical records data for 7,120 patients with diabetes treated by 368 primary care physicians at practices affiliated with two large academic hospitals. The associations between physician volume of diabetic patients (diabetes volume) and annual A1C and LDL testing, as well as blood pressure, A1C, and LDL levels, were evaluated.

RESULTS—In multivariable analysis, absolute diabetes volume was linked to decreased odds of A1C testing (4% less for each additional patient seen; P = 0.05), and relative diabetes volume (fraction of the total patients seen who had diabetes) was associated with decreased odds of both A1C (25% less for every 10% increase in the number of diabetic patients seen annually; P = 0.03) and LDL testing (20% less for every 10% increase in the number of diabetic patients; P < 0.001). Physician volume was not significantly associated with the odds of blood pressure, A1C, or LDL control at the end of the study.

CONCLUSIONS—Higher physician volume in care of diabetic patients is associated with decreased adherence to surveillance guidelines and no measurable difference in treatment outcomes.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 2 March 2007. DOI: 10.2337/dc07-0029.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted February 16, 2007.
    • Received January 7, 2007.
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This Article

  1. Published online before print March 2, 2007, doi: 10.2337/dc07-0029 Diabetes Care June 2007 vol. 30 no. 6 1442-1447
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