WellStar School of Nursing
Introduction: The purpose of this study was to examine the effect of payer status on indicators of the quality of diabetes care delivered in four health care systems that participated in a REACH Coalition’s efforts to eliminate health care disparities for African Americans with diabetes.
Design and Methods: Secondary analyses of data from 899 health care records of people who received diabetes care were conducted to determine differences in quality of care by payer status. Extracted information included process information related to frequency of A1C, lipid, and kidney tests, foot examinations, and blood pressure measurements, as well as intermediate health outcomes for blood pressure control, A1C results, lipid results, and kidney tests. Multivariate logistic regression, which included variables that had a change >10% for any payer status (based on odds ratio), was used to predict the likelihood of a person with diabetes receiving a care measure and/or achieving desired health outcomes related to diabetes control.
Results: There were no significant differences observed except: (1) LDL cholesterol control where Medicare enrollees and Medicaid recipients experienced poorer outcomes than those with commercial insurance (p = 0.04 for both); and (2) foot exams where Medicaid recipients received fewer annual exams than those with no insurance (p = 0.034).
Conclusions: Payer status had little effect on quality of diabetes care among this population. Other influences not accounted for in this study apparently have a great impact on quality of care in these four health systems.
Southern Online Journal of Nursing Research