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dc.contributor.authorYasaitis, Laura C.en_US
dc.contributor.authorBubolz, Thomasen_US
dc.contributor.authorSkinner, Jonathan S.en_US
dc.contributor.authorChandra, Amitabhen_US
dc.date.accessioned2014-12-02T21:27:47Z
dc.date.issued2014en_US
dc.identifier.citationYasaitis, Laura C., Thomas Bubolz, Jonathan S. Skinner, and Amitabh Chandra. 2014. “Local Population Characteristics and Hemoglobin A1c Testing Rates among Diabetic Medicare Beneficiaries.” PLoS ONE 9 (10): e111119. doi:10.1371/journal.pone.0111119. http://dx.doi.org/10.1371/journal.pone.0111119.en
dc.identifier.issn1932-6203en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:13454685
dc.description.abstractBackground: Proposed payment reforms in the US healthcare system would hold providers accountable for the care delivered to an assigned patient population. Annual hemoglobin A1c (HbA1c) tests are recommended for all diabetics, but some patient populations may face barriers to high quality healthcare that are beyond providers' control. The magnitude of fine-grained variations in care for diabetic Medicare beneficiaries, and their associations with local population characteristics, are unknown. Methods: HbA1c tests were recorded for 480,745 diabetic Medicare beneficiaries. Spatial analysis was used to create ZIP code-level estimated testing rates. Associations of testing rates with local population characteristics that are outside the control of providers – population density, the percent African American, with less than a high school education, or living in poverty – were assessed. Results: In 2009, 83.3% of diabetic Medicare beneficiaries received HbA1c tests. Estimated ZIP code-level rates ranged from 71.0% in the lowest decile to 93.1% in the highest. With each 10% increase in the percent of the population that was African American, associated HbA1c testing rates were 0.24% lower (95% CI −0.32–−0.17); for identical increases in the percent with less than a high school education or the percent living in poverty, testing rates were 0.70% lower (−0.95–−0.46) and 1.6% lower (−1.8–−1.4), respectively. Testing rates were lowest in the least and most densely populated ZIP codes. Population characteristics explained 5% of testing rate variations. Conclusions: HbA1c testing rates are associated with population characteristics, but these characteristics fail to explain the vast majority of variations. Consequently, even complete risk-adjustment may have little impact on some process of care quality measures; much of the ZIP code-related variations in testing rates likely result from provider-based differences and idiosyncratic local factors not related to poverty, education, or race.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pone.0111119en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215926/pdf/en
dash.licenseLAAen_US
dc.subjectMedicine and Health Sciencesen
dc.subjectEpidemiologyen
dc.subjectSocial Epidemiologyen
dc.subjectSpatial Epidemiologyen
dc.subjectHealth Careen
dc.subjectHealth Care Policyen
dc.subjectHealth Care Policy Reportsen
dc.subjectHealth Systems Strengtheningen
dc.subjectGeographic and National Differences in Health Careen
dc.subjectHealth Care Qualityen
dc.subjectHealth Services Administration and Managementen
dc.subjectHealth Services Researchen
dc.subjectSocioeconomic Aspects of Healthen
dc.titleLocal Population Characteristics and Hemoglobin A1c Testing Rates among Diabetic Medicare Beneficiariesen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS ONEen
dash.depositing.authorYasaitis, Laura C.en_US
dc.date.available2014-12-02T21:27:47Z
dc.identifier.doi10.1371/journal.pone.0111119*
dash.contributor.affiliatedYasaitis, Laura C.


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