Treatment approaches and costs associated with diabetes clinical metrics as measured by Healthcare Effectiveness Data and Information Set (HEDIS).

BACKGROUND: The clinical outcomes of diabetes can be influenced by primary care providers' (PCP) treatment approaches. This study explores the association between PCP approaches to management and performance measured by established diabetes metrics and related costs. METHODS: In phase one, Electronic Medical Records were used to extract diabetes related metrics using Healthcare Effectiveness Data and Information Set (HEDIS), for patients with diabetes who had office visits to 44 PCP practices from April 2019 to March 2020. Using those metrics and scoring system, PCP practices were ranked and then categorized into high- and low-performing groups (top and bottom 25%, n = 11 each), with a total of 19,059 clinic visits by patients with a diagnosis of diabetes. Then extensive analysis was performed to evaluate a correlation between treatment approaches and diabetes outcomes across the top and bottom performing practices. In phase 2, patients with diabetes who were attributed to the aforementioned PCP practices were identified in a local health plan claims data base (a total of 3,221 patients), and the allowed amounts from their claims were used to evaluate differences in total and diabetes-related healthcare costs by providers' performance. RESULTS: Comparing 10,834 visits in high-performing practices to 8,235 visits in low-performing practices, referrals to certified diabetes care and education specialists and provider-to-provider electronic consults (e-consults) were higher in high-performing practices (Z = 6.06, p < .0001), while traditional referrals were higher in low-performing practices (Z = -6.94, p < .0001). The patient-to-provider ratio was higher in the low-performing group (M = 235.23) than in the high-performing group (M = 153.26) (Z = -2.82, p = .0048). Claims data analysis included 1,825 and 1,396 patients from high- and low-performing providers, respectively. The patient-to-provider ratio was again higher in the low-performing group (p = .009, V = 0.62). Patients receiving care from lower-performing practices were more likely to have had a diabetes-related hospital observation (5.7% vs. 3.9%, p = .02; V = 0.04) and higher diabetes-related care costs (p = .002; d = - 0.07); these differences by performance status persisted when controlling for differences in patient and physician characteristics. Patients seeing low-performing providers had higher Charlson Comorbidity Index scores (Mdn = 3) than those seeing high-performing providers (Mdn = 2). CONCLUSIONS: Referrals to the CDCES and e-Consult were associated with better measured diabetes outcomes, as were certain aspects of cost and types of hospital utilization. Higher patients to providers ratio and patients with more comorbidities were observed in low performing group.

Hospital-Care Utilization and Medical Cost Patterns Among Patients With Insulin-Dependent Diabetes.

OBJECTIVE: Using claims data from an integrated payer-provider, we compared costs incurred by patients with insulin-dependent diabetes mellitus (IDDM) who received Hospital Inpatient/Observation/EmeRgency Department care (HIghER care) for diabetes-related events with those who did not receive such care to identify a target population for interventions in future studies. METHODS: A retrospective study pooled real-world claims data for IDDM (type 1 or type 2) between July 1, 2018, and June 30, 2019. Medical claims were used to calculate the total and diabetes-related allowed medical costs to the enterprise and per member per month costs. RESULTS: Medical and prescription drug coverage from 19 378 members was analyzed. Only 8.4% of the IDDM population received HIghER care but incurred 20% of medical expenses and nearly 40% of diabetes-related medical costs. For HIghER care patients, medical spending was higher in every inpatient and outpatient category (Wilcoxon 2-sample tests, all P < .0001). Non-diabetes-related prescription drug costs were greater in this group (Wilcoxon test, Z = 2.2879, P = .0221), whereas diabetes-related prescription drug costs were higher for non-HIghER care (Wilcoxon test, Z = -9.5918, P < .0001). In a longitudinal study of 29 602 patients over 24 months, previous-year receipt of HIghER care was a significant predictor of HIghER care the subsequent year (odds ratio, 3.28). CONCLUSION: Medical spending for patients receiving HIghER care was disproportionately high and greater in every inpatient and outpatient category. HIghER care receipt the previous year was highly predictive of HIghER care episodes the following year.

Perspectives of Health Care Providers in an Integrated Health Care Delivery Network on Inpatient Electronic Consultation (e-Consult) Use During the COVID-19 Pandemic.

A large academic hospital system (Allegheny Health Network) introduced inpatient electronic consultations (e-Consults) during the COVID-19 crisis. Providers were invited to complete an anonymous survey on their perceptions of e-Consults. Descriptive statistics were used to analyze Likert-scale data. Cronbach's alpha was used to assess internal consistency. Ninety-five providers completed the survey. Requesting and consulting providers agreed that e-Consults were easy to use (100% and 96.2%, respectively). Both groups also concurred that e-Consults either decreased or did not significantly impact their workload (81% and 74%, respectively) and that training was appropriate (77.8% and 86.8%, respectively). The advantage and barrier selected most frequently by specialists was "timelier completion of the consult versus in-person" and "inadequate information to complete the consult," respectively. The disadvantage selected most frequently by requesting physicians was "lack of communication between providers." Open-ended comments were categorized into themes. Concerns were raised regarding whether provider-provider communication via this platform offered enough information to make recommendations compared to traditional encounters. The perceived benefits and barriers of e-Consults should be further explored with the goal of improving patient care delivery and provider satisfaction.

Depression Before and After a Diagnosis of Pancreatic Cancer: Results From a National, Population-Based Study.

OBJECTIVES: The aim of this study was to evaluate depression in pancreatic cancer (PC) patients before and after a cancer diagnosis using a US-based healthcare database. We also sought to study the impact of treatment of depression in PC patients on all-cause mortality. METHODS: Pancreatic cancer patients with comorbid depression in Explorys (1999-2019) were compared with controls using odds ratios with 95% confidence intervals. Rates of depression diagnosed within 6 months, 1 year, and 3 years before and after a PC diagnosis were recorded. Patients who developed depression after a PC diagnosis were further categorized into those treated for depression using mental health professionals (MHPs), pharmacologic treatment, or both (2015-2019). RESULTS: Of the 62,450 PC patients, 10,220 (16.4%) were diagnosed with depression before PC and 8130 (13%) were diagnosed with depression after PC. Patients diagnosed with depression after PC had a significantly higher all-cause mortality than patients with PC alone (P < 0.0001). Involvement of MHP significantly improved all-cause mortality (P = 0.0041). CONCLUSIONS: Most post-PC depression is diagnosed in the first 6 months after a PC diagnosis. Although depression significantly increases PC mortality, integrating MHP in the care of PC patients with depression improves outcomes.