Racial Comparisons of Diabetes Care and Intermediate Outcomes in a Patient-Centered Medical Home

  1. Rachel Hess, MD, MS2
  1. 1Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
  2. 2Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
  3. 3VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
  4. 4Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL
  5. 5School of Medicine, University of Pittsburgh, Pittsburgh, PA
  1. Corresponding Author: Joseph A Simonetti, E-mail: simonja{at}uw.edu

Abstract

OBJECTIVE To assess racial differences in diabetes processes and intermediate outcomes of care in an internal medicine, patient-centered medical home (PCMH) group practice.

RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 1,457 adults with diabetes receiving care from 89 medical providers within a PCMH-designated, academic practice between July 1, 2009 and July 31, 2010. We used mixed-models to assess independent associations between patient race (non-Hispanic white or black) and 1) receipt of processes of care (A1C and LDL testing, foot and retinal examination, and influenza and pneumococcal vaccination) and 2) achievement of intermediate outcomes (LDL<100mg/dL, BP<140/90mmHg, A1C<7.0% [<53mmol/mol] and A1C>9.0% [>75mmol/mol]), controlling for sociodemographic factors, health status, treatment intensity and clinical continuity.

RESULTS Compared to non-Hispanic white patients, black patients were younger, more often single, had lower educational attainment and were less likely to have commercial insurance. In unadjusted analyses, fewer black patients received a retinal examination and influenza vaccination during the study period, or any lifetime pneumococcal vaccination (p<0.05; all comparisons). Fewer black patients achieved an LDL<100mg/dL, BP<140/90mmHg, or A1C<7.0% (<53mmol/mol), while more black patients had an A1C>9.0% (>75mmol/mol) [p<0.05; all comparisons]. In multivariable models, black patients were less likely to receive A1C testing (OR 0.57; 95% CI 0.34-0.95) or influenza vaccination (OR 0.75; 95% CI 0.57-0.99), or to achieve an LDL<100mg/dL (OR 0.74; 95% CI 0.55-0.99) or BP<140/90mmHg (OR 0.64; 95% CI 0.49-0.84).

CONCLUSIONS Racial differences in processes and intermediate outcomes of diabetes care were present within this PCMH-designated practice, controlling for differences in sociodemographic, clinical, and treatment factors.

  • Received June 4, 2013.
  • Accepted November 11, 2013.

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