■医院系统和保险公司收购私人拥有的医生实践并随后将其转换为垂直整合的实践的趋势。这项研究的目的是观察医疗实践所有权的这种变化是否会影响对1型和2型糖尿病管理临床指南的遵守。
■这是一项观察性研究,使用来自全国门诊医疗调查的汇总横断面数据(2014-2016年和2018-2019年)。美国诊所就诊的全国代表性概率样本。总共分析了7499次慢性常规随访和对非综合(单独和小组医师实践)和综合实践的预防性护理访问,以查看是否提供了指南一致的护理。措施包括每年为1型和2型糖尿病患者推荐的7项服务(HbA1c,脂质面板,血清肌酐,抑郁症筛查,流感免疫接种,足部检查,和BMI)。
■与非综合医师实践相比,垂直整合的做法有更高的血红蛋白A1C检测率(比值比1.58[95%CI1.07-2.33],P<.05),血清肌酸测试(比值比1.53[95%CI1.02-2.29],P<.05),足部检查(赔率比2.03[95%CI0.98-4.22],P=.058),和BMI测量(比值比1.54[95%CI0.99-2.39],P=.054)。在脂质面板测试中没有显着差异,抑郁症筛查,或流感免疫接种。
■我们的结果表明,综合医疗实践比非综合实践对糖尿病实践指南的依从性更高。然而,无论所有权如何,提供的服务费率都很低。
UNASSIGNED: There has been a trend toward hospital systems and insurers acquiring privately owned physician practices and subsequently converting them into vertically integrated practices. The purpose of this study is to observe whether this change in ownership of a medical practice influences adherence to clinical
guidelines for the management of type 1 and type 2 diabetes.
UNASSIGNED: This is an observational study using pooled cross-sectional data (2014-2016 and 2018-2019) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. A total of 7499 chronic routine follow ups and preventative care visits to non-integrated (solo and group physician practices) and integrated practices were analyzed to see whether
guideline concordant care was provided. Measures included 7 services that are recommended annually for individuals with type 1 and type 2 diabetes (HbA1c, lipid panel, serum creatinine, depression screening, influenza immunization, foot examination, and BMI).
UNASSIGNED: Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.58 [95% CI 1.07-2.33], P < .05), serum creatine testing (odds ratio 1.53 [95% CI 1.02-2.29], P < .05), foot examinations (odds ratio 2.03 [95% CI 0.98-4.22], P = .058), and BMI measuring (odds ratio 1.54 [95% CI 0.99-2.39], P = .054). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations.
UNASSIGNED: Our results show that integrated medical practices have a higher adherence to diabetes practice
guidelines than non-integrated practices. However, rates of services provided regardless of ownership were low.