Table 3.
The Association of Reimbursement Composition and Hypertension and Diabetes Quality Indicators
| Reimbursement Composition | Controlled Hypertension (BP < 140/90) in Patients with Hypertensiona % or aOR (95% CI) (N = 36,540) |
p-value | Controlled Diabetes (HbA1c < 7%) in Patients with Diabetesb % or aOR (95% CI) (N = 6016) |
p-value | ACEi/ARB Use in Patients with Diabetes and Hypertension % or aOR (95% CI) (N = 11,983) |
p-value | Statin Use in Patients Age 40–75 with Diabetes % or aOR (95% CI) (N = 10,985) |
p-value |
|---|---|---|---|---|---|---|---|---|
| Unadjusted Prevalence | ||||||||
| Majority Capitation | 71% | 0.388 | 57% | 0.586 | 54% | 0.341 | 37% | 0.431 |
| Majority FFS | 74% | (ref.) | 59% | (ref.) | 50% | (ref.) | 40% | (ref.) |
| Other Revenue Mix | 75% | 0.499 | 63% | 0.268 | 46% | 0.131 | 32% | 0.004 |
| Model 1 | ||||||||
| Majority Capitation | 0.84 (0.60–1.18) | 0.313 | 0.98 (0.65–1.49) | 0.932 | 1.09 (0.81–1.46) | 0.589 | 0.80 (0.54–1.20) | 0.282 |
| Majority FFS (ref.) | 1 | – | 1 | – | 1 | – | 1 | – |
| Other Revenue Mix | 1.09 (0.89–1.33) | 0.399 | 1.42 (1.01–2.00) | 0.044 | 0.80 (0.60–1.07) | 0.136 | 0.68 (0.50–0.90) | 0.009 |
| Model 2 | ||||||||
| Majority Capitation | 0.86 (0.65–1.15) | 0.318 | 0.90 (0.59–1.38) | 0.640 | 1.03 (0.74–1.44) | 0.864 | 0.86 (0.59–1.25) | 0.425 |
| Majority FFS (ref.) | 1 | – | 1 | – | 1 | – | 1 | – |
| Other Revenue Mix | 1.10 (0.90–1.34) | 0.355 | 1.36 (0.98–1.90) | 0.069 | 0.83 (0.61–1.11) | 0.210 | 0.69 (0.52–0.93) | 0.014 |
CKD chronic kidney disease, BP blood pressure, aOR adjusted odds ratio, CI confidence interval, HbA1c Hemoglobin A1c, ACEi Angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, NSAID nonsteroidal anti-inflammatory drug
Differences in the unadjusted prevalence of quality indicators across reimbursement types were assessed using unadjusted logistic regression
Model 1 – adjusted for patient characteristics: age, sex, race, comorbidities, total number of chronic conditions, and patient payor type
Model 2 – adjusted for Model 1 + physician/practice characteristics: United States Census Region, metropolitan statistical area, solo practice, physician specialty, physician compensation, practice ownership, and physician employment status
aHypertension and nonmissing blood pressure reading
bDiabetes and nonmissing HbA1c data