Abstract
Background
The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We aimed to assess the adherence to guidelines and its impact on hospitalization using a simple set of performance measures among patients with diabetes.
Methods
We performed a retrospective cohort study, using health care claims data for adult patients with treated diabetes (2011–2013). Patients were categorized into three drug treatment groups (with oral antidiabetic agents [OAs] only, in combination with insulin, and insulin only). Performance measures were based on international established guidelines for diabetes care. Multivariate logistic regression models predicted the probability of hospitalization (2013) by adherence level (2011) among all treatment groups.
Results
A total of 40,285 patients with diabetes were enrolled in 2011. Guideline adherence was quite low: about 70% of all patients received a biannual hemoglobin A1c measurement and 19.8% had undergone an annual low-density lipoprotein cholesterol test. Only 4.8% were exposed to full adherence including all performance measures (OAs: 3.7%; insulin: 7.7%; and in combination: 7.2%). Increased guideline adherence was associated with decreased probability of hospitalization. This effect was strongest in patients using OAs and insulin in combination.
Conclusion
Our study showed that measures to reflect physicians’ guideline adherence in diabetes care can easily be calculated based on already available datasets. Furthermore, these measures are clearly linked with the probability of hospitalization suggesting that a better guideline adherence by physicians could help to prevent a large number of hospitalizations.
Acknowledgments
This study received funding from Merck, Sharp and Dohme (MSD), Switzerland. We thank MSD for supporting our study. CAH, RR, and OR received funding from MSD. MB received consulting fees from MSD. TR received no funding. The sponsor had no role in collection, analysis, and interpretation of data; writing of the paper; or in the decision to submit the paper for publication.
Author contributions
All authors contributed substantially to conceptual development, the study design, and interpretation of data. CAH and RR analyzed the data and CAH drafted the manuscript. All authors critically revised the article for important intellectual contents and gave the final approval of the version to be published. Furthermore, they agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Disclosure
The authors report no conflicts of interest in this work.