Table 2. Changes in Quality of Care Measures and Health Care Utilization Among Patients of CoEPCE Resident Clinicians and Patients of Non-CoEPCE Resident Clinicians Before and After Initiative Launch.
| Outcome | Estimated Probability (95% CI)a | Difference in Differences | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Patients of Non-CoEPCE Resident Clinicians | Patients of CoEPCE Resident Clinicians | |||||||||
| 2008-2010 | 2011-2014 | Difference | P Value | 2008-2010 | 2011-2014 | Difference | P Value | Difference | P Value | |
| Annual HbA1c test | 0.960 (0.951 to 0.968) | 0.962 (0.955 to 0.969) | 0.002 (–0.007 to 0.012) | .61 | 0.952 (0.942 to 0.961) | 0.961 (0.952 to 0.969) | 0.009 (–0.002 to 0.020) | .10 | 0.007 (–0.007 to 0.021) | .37 |
| Poor HbA1c control | 0.194 (0.177 to 0.212) | 0.233 (0.216 to 0.250) | 0.039 (0.020 to 0.058) | <.001 | 0.234 (0.214 to 0.253) | 0.226 (0.207 to 0.245) | –0.007 (–0.030 to 0.015) | .51 | –0.046 (–0.075 to –0.018) | .001 |
| Annual renal test | 0.843 (0.823 to 0.863) | 0.830 (0.810 to 0.850) | –0.013 (–0.030 to 0.004) | .13 | 0.827 (0.805 to 0.848) | 0.845 (0.825 to 0.866) | 0.019 (–0.001 to 0.039) | .07 | 0.032 (0.006 to 0.057) | .02 |
| Hypertension control | 0.643 (0.594 to 0.691) | 0.628 (0.580 to 0.677) | –0.014 (–0.037 to –0.009) | .22 | 0.629 (0.581 to 0.677) | 0.610 (0.560 to 0.659) | –0.019 (–0.042 to 0.004) | .10 | –0.005 (–0.037 to 0.027) | .77 |
| High-risk medication | 0.302 (0.276 to 0.328) | 0.251 (0.228 to 0.274) | –0.051 (–0.062 to –0.040) | <.001 | 0.312 (0.286 to 0.339) | 0.238 (0.216 to 0.260) | –0.074 (–0.088 to –0.061) | <.001 | –0.023 (–0.040 to –0.006) | .01 |
| Timely mental health referral | 0.166 (0.142 to 0.190) | 0.178 (0.153 to 0.203) | 0.012 (–0.006 to 0.018) | <.001 | 0.182 (0.157 to 0.208) | 0.211 (0.182 to 0.239) | 0.028 (0.021 to 0.036) | <.001 | 0.016 (0.006 to 0.026) | .002 |
| Primary care mental health integrated visit | 0.025 (0.006 to 0.043) | 0.033 (0.009 to 0.057) | 0.008 (0.002 to 0.015) | .01 | 0.012 (0.003 to 0.021) | 0.019 (0.005 to 0.034) | 0.008 (0.002 to 0.013) | .01 | –0.001 (–0.009 to 0.008) | .045 |
| Hospitalization for ACSC | 0.035 (0.028 to 0.041) | 0.031 (0.026 to 0.037) | –0.003 (–0.006 to –0.001) | .02 | 0.033 (0.027 to 0.041) | 0.025 (0.021 to 0.030) | –0.008 (–0.011 to –0.005) | <.001 | –0.004 (–0.009 to <0.001) | .01 |
Abbreviations: ACSC, ambulatory care–sensitive condition; CoEPCE, Centers of Excellence in Primary Care Education; HbA1c, hemoglobin A1c.
a
Results from logistic mixed effects models, with adjustment for age, gender, race/ethnicity, Elixhauser comorbidity score, and years of VA care, with site as a random effect.