Does Continuity of Care Have an Effect on Diabetes Quality Measures in a Teaching Practice in an Urban Underserved Community?

Abstract

Teaching clinics are an important source of care for urban, minority, underserved communities and face great challenges to improve quality of care for diabetics. This study examined the impact of continuity with the same primary care provider on health care process and outcome measures for patients with diabetes treated at an urban, family medicine resident teaching practice. The Modified Modified Continuity of Care Index was used to measure care continuity. The diabetes care quality measures were based on the NCQA HEDIS and Diabetes Recognition Program. Low levels of care continuity were associated with poor HbA1c control and higher levels of care continuity were associated with good LDL control. These findings suggest that improving care continuity should be considered in a systems-based approach to address disparities in diabetes care. Additional research is needed to include the patient's perspective in measuring care continuity and patient outcomes.

Impact of Continuous Care on Health Outcomes and Cost for Type 2 Diabetes Mellitus: Analysis Using National Health Insurance Cohort Database

“…Most Frequent Provider Continuity (MFPC), Modified Continuity Index (MCI), and COC index have been used as measures for continuous care [14][15][16][17][18][19][20][21]. We selected the COC index as the measure for continuity measure in this study.…”

Relationship between Continuity of Care in the Multidisciplinary Treatment of Patients with Diabetes and Their Clinical Results

“…Regarding patients with diabetes, low levels of COC have been found to be associated with poor HbA1c control [17] and a higher risk of end-stage renal disease and hospitalization [13], while high levels of COC were associated with good LDL control [17], lower costs (considering diabetes-related hospitalization and emergency visits) [39] and lower odds of being admitted to the hospital [40]. Some studies have found no association between COC and HbA1c, lipid, or eye exam frequency [41].…”

“…For analysis purposes, we consider as inclusion criteria that the patient has had at least 12 months of treatment in the centers, in which time each individual was subject to at least two HbA1c tests, in order to establish evolution. The time of analysis was bounded to a maximum of 24 months, similar to timeframes utilized in previous research [10,17,37]. Most of the patients had been receiving care for a longer period of time.…”

“…Research shows a relationship between COC and greater patient satisfaction [9], falling hospitalization rates and emergency department visits [10][11][12][13], and a reduction in mortality [8]. In the case of diabetes, continuity is particularly important [14][15][16], with evidence showing the relationship between low continuity and poor glycated hemoglobin (HbA1c) control, and high continuity and positive control of low-density lipoprotein cholesterol (LDL-C) [17]. Research highlights the importance of incorporating other professionals within T2DM treatment teams [3].…”

Continuity of Care in Resident Outpatient Clinics: A Scoping Review of the Literature

“…The MMCI was reported in 6 studies, representing over 6700 patients. 26,32,44,50,53,55 Median baseline MMCI was 59 (SD ¼ 12.9, range, 43-76).…”