Practice-Level Variation in Statin Use Among Patients With Diabetes

255 Background: While there is increased attention on the importance of quality measurement in oncology, especially with the rise of value-based payment, limited data exist on national averages and practice level variation for proposed quality measures to establish benchmarks and targets for quality improvement initiatives or value-based contracts. Methods: UnitedHealthcare (UHC) developed peer comparison reports for eight cross cutting quality measures for practices with an active contract for at least one of its commercial, Medicare or Medicaid health plans and ≥1 provider from the following specialties: gynecologic oncology, hematology/oncology, pediatric hematology/oncology, radiation oncology, or surgical oncology. Adherence to the quality measures below was calculated using a mix of claims data, clinical data from a prior authorization for cancer therapy, and CMS MIPS data. Patients were attributed through an algorithm that selected the most probable physician responsible for the patient’s care - responsible prior authorization provider, servicing provider or most recent visited provider prior to the treatment, varying by each measure. Dates of service differ by measure, ranging from 1/1/2019 through 12/31/2020. Results: We identified 5,828 unique tax identification numbers (TINs) with UHC members with cancer attributed to them during 2019-20. The number of practices included in the measurement cohort per measure varied significantly from 301 to 4,120 (tobacco screening and performance status, respectively). 2,422 TINs met the minimum patient count for at least one measure (≥10 patients or events). Overall performance ranged from 13.5% to 77.3% (hospice admission and PS documented) for measures where higher adherence reflects better quality of care. For measures where lower scores represent higher quality of care the range was 11.4% to 22.6% (hospice < 3 days and ED admission, respectively). Observed adherence was statistically better than expected for 0.5%-5.8% and statistically less than expected for 0.9%-5.6% of TINs in UHC’s network; however, more than half of the practices had insufficient sample size to make a determination. Conclusions: We observed substantial variation in quality across a national cohort of oncology practices. However, even for a large national payer, small sample sizes limited the assessment of a substantial number of practices.[Table: see text]

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Practice-level variation in postoperative pain management after ureteroscopy (URS): Lessons from a statewide collaborative quality initiative

European Urology Supplements ◽

10.1016/s1569-9056(19)30026-0 ◽

2019 ◽

Vol 18 (1) ◽

pp. e37-e38

Author(s):

C. Dauw ◽

K. Swarna ◽

J. Qi ◽

T. Kim ◽

J. Telang ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Level Variation ◽

Practice Level

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Effect of Different Factors on Glycosylated Hemoglobin (HbA1c) Levels Among Diabetes Mellitus Patients

10.53350/pjmhs2115123513 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3513-3515

Author(s):

Bader Alsuwayt

Keyword(s):

Diabetes Mellitus ◽

Glycated Hemoglobin ◽

Glycosylated Hemoglobin ◽

Diabetic Patients ◽

Study Results ◽

Patients With Diabetes ◽

Insulin Use ◽

Low Rate ◽

Statin Use ◽

Hba1c Levels

Aim: To describe the rate of the controlled level of glycosylated hemoglobin (HbA1c) among diabetes mellitus patients in Dammam city, Kingdom of Saudi Arabia (KSA). To assess the association between the status of HbA1c and the different patient-related factors namely: insulin use, metformin, dyslipidemia, and statin use. Methods: This cross-sectional study was performed at Security Forces Hospital, Dammam, KSA, between November 2020 and February 2021. A sample of two hundred known diabetic patients who were regularly followed up at the outpatient department (OPD) was selected randomly for the current study. Results: A very low rate (24%) of controlled HbA1C levels in patients with diabetes (type 1 DM and type 2 DM), The data showed that 85 % of all participants in our study are T2DM patients, while only 15% are T1DM patients, Our data showed that patients with dyslipidemia, hypothyroidism, or hypertension have a high level of uncontrolled HbA1C levels. Surprisingly, both dyslipidemia and statin use were predictors of uncontrolled HbA1C, Unexpectedly, non-metformin use has a protective effect toward controlling HbA1C, While insulin use is a strong predictor of uncontrolled HbA1C (OD 5.20). Conclusion: A low rate of controlled glycated hemoglobin (HbA1c) level among patients with diabetes (T1DM and T2DM) in our sample urges the need for immediate intervention to investigate and improve the current findings. Further investigations are needed to fully explain the high rate of uncontrolled HbA1c among insulin, metformin and statins users. Keywords: Glycated hemoglobin, HbA1c, Diabetes mellitus, Statins, Metformin.

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Abstract 75: Practice-level Variation in use of Recommended Medications among Outpatients with Heart Failure: Insights from the NCDR PINNACLE Program

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a75 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Pamela N Peterson ◽

Paul S Chan ◽

John A Spertus ◽

Fengming Tang ◽

Phil Jones ◽

...

Keyword(s):

Heart Failure ◽

Rate Ratio ◽

Angiotensin Receptor Blockers ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Level Variation ◽

Ventricular Ejection Fraction ◽

Practice Level ◽

Patient Level ◽

The Mean

Background: Beta-blockers (BB) and angiotensin converting enzyme inhibitors (ACE)/angiotensin receptor blockers (ARB) are guideline recommended therapies for ambulatory heart failure patients with reduced left ventricular ejection fraction (HFREF). Real-world use of these therapies is suboptimal. Whether variations in treatment are dominated by practice-level or patient-level factors is unknown. Methods: Practices participating in the NCDR PINNACLE program, a national office-based cardiac quality improvement registry, between July 2008 and December 2010 were evaluated. Rates of treatment with BB and ACE/ARB were evaluated in patients with HFREF (EF ≤40%) and no documented contraindication. Multivariable hierarchical relative risk regression models, including demographics, insurance status, comorbidities and a random effect for practice were used to determine 1) patient-level and 2) practice-level variation in treatment rates. To quantify practice-level variation, the median rate ratio (MRR) was calculated, which estimates the typical rate ratio between two randomly selected practices for patients with identical covariates. In general, MRRs ≥ 1.2 indicate significant variation by practice. The MRR is always >1.0 but can be compared in magnitude to patient-level risks. Results: We studied 12384 patients in 45 practices. The mean practice rate for BB treatment was 87% (IQR 83%-95%; range: 43%-100%), and the mean practice rate of ACE/ARB treatment was 90% (IQR 75%-88%; range: 18%-100%). The MRR was 1.09 for BB and 1.16 for ACE/ARB therapy. For both BB and ACE/ARB, the adjusted MRR for site level variation was larger than the rate ratio for other patient factors. (Table) Conclusions: Although rates of BB and ACE/ARB treatment among outpatients with HFREF are high, clinically meaningful variation by practice is present and explains a larger amount of the observed variance than any patient characteristic. This suggests that addressing practice-level factors represents an important opportunity to improve the use of evidence-based HF therapy.

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