Results: Medication intensification was assessed at all primary care visits at which the last known A1c level was > 7%. Patients were also classified as being within one of the following states of glucose control based on their first and last A1c during the 16 month study period: maintaining A1c below goal, A1c relapse from goal, newly achieving A1c goal, and A1c persistently above goal.
Results: There were no differences between optimal PCP physicians and their peers in specialty (p=0.13), number of diabetes patients (p=0.94), percentage relapse patients, or percentage maintaining goal. However, optimal physician patients more often achieved glucose goals (23.1% vs. 18.9%; p=0.0290). Optimal physicians intensified glucose-lowering medications at a mean A1c of 7.8% vs. 8.4% for peers (p=0.01)
Conclusion: Optimal physicians have a much lower A1c threshold for treatment intensification compared to their lower-performing peers; this observation suggests an important potential intervention pathway to improve diabetes care. Another potential improvement pathway for all PCPs would be to reduce rates of relapse from controlled to uncontrolled A1c levels. Purpose: There is a great deal of variation in quality of diabetes care across physicians but our understanding of what distinguishes optimal physicians from their lower-performing peers is incomplete.
Methods: We identified the 25% (N=20) of primary care physicians (PCP) with the highest proportion of diabetes patients achieving a composite A1c, BP, lipid, aspirin and smoking goal, and compared them to their lower-performing peers (N=60).