Certain physician- and practice-level factors may be associated with quality of care in diabetes, according to a recent study.
Researchers performed a systematic review and meta-analysis of studies in adults with diabetes published from January 1990 to March 2019 that examined the relationship between physician and practice characteristics and an objective measure of care quality. Meta-analyses were conducted when at least two studies looked at a comparable individual or composite quality measure, and a narrative synthesis was done for studies that could not be included in a meta-analysis.
The primary outcome was quality of diabetes care, which comprised individual objective measures of quality; performance of care processes or control of intermediate clinical outcomes (e.g., blood pressure, cholesterol, HbA1c); screening for complications or attendance at screening services; prescribing of appropriate medications, treatment inertia or intensification; or a composite of individual measures. Patient-reported outcomes such as functional status and health-related quality of life were secondary outcomes. Results were published Feb. 3 by the Journal of General Internal Medicine.
Eighty-two studies were included, with a varied range of individual and composite quality measures. Female versus male physicians (nine studies; odds ratio [OR], 1.07; 95% CI, 1.04 to 1.10), higher versus lower diabetes volume (four studies; OR, 1.24; 95% CI, 1.05 to 1.47), and electronic health record (EHR) use versus no EHR (four studies; OR, 1.43; 95% CI, 1.11 to 1.84) were associated with higher-quality care. No association was seen between quality of care and physician experience, practice location, or type of practice. The narrative synthesis indicated a possible association between older physician age and higher socioeconomic deprivation in a practice's patient population and lower-quality care.
The authors noted that most of the included studies were cross-sectional and that the causal relationships were tentative. However, they concluded that their findings “may inform targeted support of practice-level improvements and guide strategies to better implement structured diabetes management.” They called for additional research into the ways physician characteristics and diabetes volume may influence care quality, as well as the potential effects of practice type and location. “Lastly, agreement on standard composite quality measures is crucial to increase comparability across studies and establish a clear picture of the quality of diabetes management in primary care,” the authors wrote.