Results: This study examines the diabetes practice patterns of primary care physicians (PCPs) and tests the hypothesis that PCPs who provide better quality diabetes care have higher rates of treatment intensification.
Study subjects included 80 PCPs at a large medical group in Minnesota, who were ranked on quality of diabetes care using a composite diabetes quality of care measure. Data on use of glucose-lowering pharmacotherapy was combined with laboratory data indicating the level of glycated hemoglobin (A1c) at the time of each office visit to examine differences in patterns of glucose-related treatment intensification as a function of the physicians' quality of care. GLM statistical models were used to assess the relationship.
Optimal PCPs, defined as the top quartile of PCPs, had higher rates of treatment intensification than their less well performing peers. Optimal PCP's initiated (p=0.08) and titrated (p=0.02) glucose-lowering therapy at lower A1c levels than their peers. Optimal practice PCPs exhibited a proactive feedforward treatment strategy, while their less well-performing peers exhibited a reactive feedback treatment strategy.
There was significant variation in rates of treatment intensification and in trigger levels of A1c at which different PCPs initiated or intensified glucose-lowering therapy in their adult patients with diabetes. Optimal docs had higher rates of treatment intensification. Clinical decision support interventions to promote appropriate treatment intensification have great potential to improve diabetes care.