Table 5.
Association Between Sponsoring Institution Characteristics, Training HSA Spending category, and Quality Measures for Diabetic Patients
| Hemoglobin A1c Test | LDL Screening | Nephropathy Screening | Eye Exam | Summary Score | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| OR (95% CI) | P Value | OR (95% CI) | P Value | OR (95% CI) | P Value | OR (95% CI) | P Value | OR (95% CI) | P Value | |
|
|
||||||||||
| Sponsoring Institution Characteristics | ||||||||||
| Percent of graduates in rural practice | 0.98 (0.31–3.04) | .97 | 0.53 (0.19–1.42) | .20 | 0.58 (0.23–1.49) | .26 | 0.91 (0.67–1.24) | .56 | 0.88 (0.67–1.16) | .35 |
| Percent of graduates in primary care | 1.10 (0.58–2.08) | .76 | 1.57 (0.85–2.91) | .15 | 1.43 (0.76–2.68) | .27 | 0.94 (0.75–1.19) | .62 | 1.08 (0.93–1.26) | .32 |
| Sponsoring institution size, natural log | 1.09 (0.98–1.22) | .12 | 1.10 (0.99–1.23) | .08 | 1.12 (1.00–1.25) | .06 | 1.00 (0.96–1.04) | .92 | 1.03 (1.00–1.05) | .05 |
| Training HSA spending categorya | ||||||||||
| Low | Reference | Reference | Reference | Reference | Reference | |||||
| Average | 0.98 (0.76–1.25) | .85 | 1.06 (0.85–1.33) | .59 | 1.04 (0.85–1.26) | .73 | 0.95 (0.88–1.02) | .14 | 1.00 (0.95–1.06) | .95 |
| High | 1.06 (0.082–1.38) | .65 | 1.14 (0.91–1.44) | .26 | 1.09 (0.89–1.34) | .40 | 1.01 (0.93–1.09) | .84 | 1.03 (0.97–1.09) | .38 |
| Practice HSA spending category | ||||||||||
| Low ($6,102 to $8,683) | Reference | Reference | Reference | Reference | Reference | |||||
| Average ($8,691 to $9,879) | 1.34 (1.03–1.73) | .03 | 1.23 (0.98–1.55) | .07 | 1.12 (0.90–1.39) | .30 | 0.95 (0.88–1.03) | .23 | 1.06 (0.99–1.12) | .08 |
| High ($9,880 to $16,542) | 1.27 (1.00–1.60) | .05 | 1.38 (1.12–1.71) | .003 | .88 (0.70–1.09) | .24 | 0.88 (0.81–0.96) | .003 | 1.03 (0.97–1.09) | .29 |
| Covariatesb | Yes | Yes | Yes | Yes | Yes | |||||
HSA = hospital service area; LDL = low-density lipoprotein.
Note: Data are based on 2011 Medicare Claims. Data are weighted and restricted to primary care physicians with 1–19 years of practice and 40 or more Medicare patients, excluding patients with total expenditures greater than $100,000. For all models, the diabetic beneficiary sample size is 126,666, and the physician sample size is 3,073.
To standardize training HSA spending, we calculated a standardized z score for HSA spending for each year between 1992 and 2010. The training HSA spending groups are Low: −1.49 to −0.14; Average: −0.13 to 0.46; High: 0.48 – 4.50. Each group has approximately the same number of beneficiaries.
See text for list of covariates.