Resource Use Among Diabetes Patients Who Mainly Visit Primary Care Physicians Versus Medical Specialists: a Retrospective Cohort Study

Background It is not uncommon for medical specialists to predominantly care for patients with certain chronic conditions rather than primary care physicians (PCPs), yet the resource implications from such patterns of care are not well understood. Objective To assess resource use of diabetes patients who predominantly visit a PCP versus a medical specialist. Design Retrospective cohort study of diabetes patients aging into the traditional Medicare program. Patients were attributed to a PCP or medical specialist annually based on a preponderance of ambulatory care visits and categorized according to whether attribution changed year to year. Propensity score weighting was used to balance baseline demographic characteristics, diabetes complications, and underlying health conditions between patients attributed to PCPs and to medical specialists. Spending and utilization were measured up to 3 patient-years. Subjects A total of 141,558 patient-years. Main Measures Total visits, unique physicians, hospital admissions, emergency department visits, procedures, imaging, and tests. Key Results Each year, roughly 70% of patients maintained attribution to a PCP and 15% to a medical specialist relative to the previous year. After propensity weighting, patients continuously attributed to a PCP versus medical specialist from 1 year to the next had lower average total payer payments ($10,326 [SD $57,386] versus $14,971 [SD $74,112], P