C-A3-02: How Do the Best Physicians Get Diabetes Patients to Glycemic Goals?

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.