Introduction & Objective: Hospital systems have recently been acquiring privately owned physician practices, converting them into vertically integrated practices. The purpose of this study is to observe if ownership of a medical practice influences adherence to clinical guidelines for management of type 1 and type 2 diabetes.
Methods: This is an observational study using pooled cross-sectional data (2014-2016, 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 seven 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, BMI).
Results: Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.59 [95% CI 1.8-2.34], P<0.05), serum creatine testing (odds ratio 1.57 [95% CI 1.04-2.35], P<0.05), foot examinations (odds ratio 2.14 [95% CI 1.05-4.36], P<0.05), and BMI measuring (odds ratio 1.73 [95% CI 1.11-2.68], P<0.05). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations.
Conclusion: Our results show that integrated medical practices have a higher adherence to diabetes practice guidelines than non-integrated practices, suggesting they may be more effective at treating chronic conditions. However, rates of services provided regardless of ownership were low. More research needs to be done on ways to improve adherence to guidelines.
N. Kostrubsky: None. J. Harman: None.
