Florida State University, Tallahassee, FL, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241259685. doi: 10.1177/21501319241259685.
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.
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).
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], < .05), serum creatine testing (odds ratio 1.53 [95% CI 1.02-2.29], < .05), foot examinations (odds ratio 2.03 [95% CI 0.98-4.22], = .058), and BMI measuring (odds ratio 1.54 [95% CI 0.99-2.39], = .054). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations.
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.
医院系统和保险公司收购私人拥有的医生诊所，并将其随后转变为垂直整合的实践，这已经成为一种趋势。本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 1 型和 2 型糖尿病管理临床指南的遵守情况。
这是一项使用来自全国门诊医疗保健调查（National Ambulatory Medical Care Survey）的汇总横断面数据（2014-2016 年和 2018-2019 年）的观察性研究，该调查是美国基于办公室的医生就诊的全国代表性概率样本。对 7499 例非整合（单人或团体医生诊所）和整合实践的慢性常规随访和预防保健就诊进行了分析，以确定是否提供了符合指南的护理。测量指标包括 7 项建议每年对 1 型和 2 型糖尿病患者进行的服务（HbA1c、血脂谱、血清肌酐、抑郁筛查、流感免疫、足部检查和 BMI）。
与非整合医生实践相比，垂直整合实践的糖化血红蛋白检测率更高（优势比 1.58 [95%置信区间 1.07-2.33]， < .05），血清肌酐检测率更高（优势比 1.53 [95%置信区间 1.02-2.29]， < .05），足部检查率更高（优势比 2.03 [95%置信区间 0.98-4.22]， = .058），体重指数测量率更高（优势比 1.54 [95%置信区间 0.99-2.39]， = .054）。血脂谱检测、抑郁筛查或流感免疫接种率无显著差异。
我们的结果表明，与非整合实践相比，整合医疗实践更遵守糖尿病实践指南。然而，无论所有权如何，提供服务的比率都很低。
