How do the best physicians get diabetes patients to glycemic goals [presentation]? Presentation uri icon
  • Objective: To examine the glucose control-related practice patterns of primary care physicians (PCP) and ascertain if those who provide better quality diabetes care have lower rates of clinical inertia.
    Methods: Study subjects included 80 PCPs at a large medial group in Minnesota, who were ranked on quality of diabetes care using a composite diabetes quality of care measure. Data on use of glucose-lowering pharmacotherapy was combined with laboratory data indicating the level of glycated hemoglobin (A1c) at the time of each office visit to examine differences in patterns of glucose-related treatment as a function of the physicians’ quality of care. GLM statistical models were used to assess the relationship.
    Results: Optimal PCPs, defined as the top quartile of PCPs, had lower rates of clinical inertia than their less well performing peers. Optimal PCPs initiated (p=0.08) and titrated (p=0.02) glucose-lowering therapy at lower A1c levels than their peers. Optimal practice PCPs exhibited a feed-forward treatment strategy, while their less well-performing peers exhibited a feedback treatment strategy.
    Conclusions: There was significant variation in rates of clinical inertia and in trigger levels of A1c at which different PCPs initiated or intensified glucose-lowering therapy in their adult patients with diabetes. Optimal docs had lower rates of clinical inertia. Interventions to reduce clinical inertia have great potential to improve diabetes care.

  • participant
  • Biltz, G. R.   Presenter  
  • Ekstrom, Heidi L.   Presenter  
  • Johnson, P. E.   Presenter  
  • O'Connor, Patrick J., MD, MA, MPH   Presenter  
  • Rush, William A., PhD   Presenter  
  • Sperl-Hillen, JoAnn M., MD   Presenter  
  • Research
  • Diabetes
  • Physician's Practice Patterns
  • Primary Health Care
  • Quality of Health Care