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High Overall Volume Could Lower Diabetes Care Quality from PCPs

TORONTO — Quality diabetes care might be getting lost in the shuffle with overall busy primary care practices, according to a new study.

Background information in the article, published in Annals of Internal Medicine, suggests that patient volume has been shown to affect quality of care delivered, whether positively or negatively. It cites a large U.S. study showing that high-volume surgeons had better mortality outcomes across eight surgical procedures compared to their low-volume counterparts.

Studies have also shown an association between high patient volume and better outcomes for heart failure and coronary artery disease, according to the Canadian researchers, who caution that much less is known about whether physician volume influences outcomes in the outpatient management of chronic diseases, such as diabetes.

For the population-based cohort study, researchers from University of Toronto, Institute for Clinical Evaluative Sciences, Toronto Rehabilitation Institute, St. Michael's Hospital, and Sunnybrook Health Sciences Centre analyzed data from provincial healthcare administrative databases in Ontario, Canada. The data, which detail virtually all care received by all residents of the province, was used to explore the associations of both overall ambulatory volume and diabetes-specific volume with quality of diabetes care among primary care physicians.

Overall, more than a million adults with diabetes in 2011 who received care from 9,014 primary care physicians were included. Two measures of volume were extracted for each physician: overall ambulatory volume — representing time available to devote to chronic disease management during patient encounters — and diabetes-specific volume — representing disease-specific expertise.

At the same time, six indicators were employed to measure quality of diabetes care over a two-year period, including disease monitoring, prescription medications, and adverse clinical outcomes.

Clear and consistent association was demonstrated between primary care physician volume and quality of diabetes management, according to the results, which indicate that patients of physicians with higher overall ambulatory volumes had consistently lower quality care.

Higher diabetes-specific volume was associated with higher quality of care across all six indicators, however, the study found.

“Primary care physicians with busier ambulatory patient practices delivered lower-quality diabetes care, but those with greater diabetes-specific experience delivered higher-quality care,” study authors concluded. “These findings show that relationships between physician volume and quality can be extended from acute care to outpatient chronic disease care. Health policies or programs to support physicians with low volume of patients with diabetes may improve care.”


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