930-P: Care Management Practices for Diabetes and Other Chronic Conditions during COVID

Background: Diabetes outcomes in primary care settings depend on specific care management processes (CMPs) provided by practices. CMPs have been tracked in Minnesota since 2017 using a practice survey that measures the presence of 1CMPs in primary care, including CMPs focused on patients with diabetes.

Method: Secondary data analysis of CMP data collected in 2017, 2019, and 2021, with a COVID supplement in 2021. The 2021 survey was conducted in February and March, between the peaks in COVID cases observed in Minnesota.

Results: Response rates for the three waves were 71%, 72% and 69%, respectively. Our analysis focuses on the 269/556 practices participating in all three waves. Overall prevalence of CMPs for this subset was not significantly different (p=0.069) than for practices that participated in only one or two waves. Among continuously participating practices, overall prevalence of CMPs increased significantly (p=0.005) in 2021. This increase was driven by CMPs focusing on chronic disease management (p=0.011) , patient self-management (p=0.013) , and development of care plans (p=0.004) . Diabetes-specific CMPs had the highest prevalence in all years relative to CMPs focused on cardiovascular disease, depression or asthma. Nearly 90% of respondent practices described moderate to extreme disruption in disease management practices during the pandemic peak. Prior to the pandemic in 2019, virtual visits (phone, video) comprised less than 20% of the total visits for almost all practices. During the 2020 peak, 29% of practices conducted 60% or more of their visits virtually, and an additional 50% of practices conducted 20%-59% of visits virtually. By early 2021, nearly all practices reported less than 40% of visits being conducted virtually.

Conclusions: Despite significant practice disruption due to the pandemic, primary care practices in Minnesota reported continued increase in CMPs supporting care for patients with diabetes and other chronic conditions.