PMID- 32139383
OWN - NLM
STAT- MEDLINE
DCOM- 20210305
LR  - 20210502
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 43
IP  - 5
DP  - 2020 May
TI  - Multilevel Variation in Diabetes Screening Within an Integrated Health System.
PG  - 1016-1024
LID - 10.2337/dc19-1622 [doi]
AB  - OBJECTIVE: Variation in diabetes screening in clinical practice is poorly 
      described. We examined the interplay of patient, provider, and clinic factors 
      explaining variation in diabetes screening within an integrated health care 
      system in the U.S. RESEARCH DESIGN AND METHODS: We conducted a retrospective 
      cohort study of primary care patients aged 18-64 years with two or more 
      outpatient visits between 2010 and 2015 and no diagnosis of diabetes according to 
      electronic health record (EHR) data. Hierarchical three-level models were used to 
      evaluate multilevel variation in screening at the patient, provider, and clinic 
      levels across 12 clinics. Diabetes screening was defined by a resulted gold 
      standard screening test. RESULTS: Of 56,818 patients, 70% completed diabetes 
      screening with a nearly twofold variation across clinics (51-92%; P < 0.001). Of 
      those meeting American Diabetes Association (ADA) (69%) and U.S. Preventive 
      Services Task Force (USPSTF) (36%) screening criteria, three-quarters were 
      screened with a nearly twofold variation across clinics (ADA 53-92%; USPSTF 
      49-93%). The yield of ADA and USPSTF screening was similar for diabetes (11% vs. 
      9%) and prediabetes (38% vs. 36%). Nearly 70% of patients not eligible for 
      guideline-based screening were also tested. The USPSTF guideline missed more 
      cases of diabetes (6% vs. 3%) and prediabetes (26% vs. 19%) than the ADA 
      guideline. After adjustment for patient, provider, and clinic factors and 
      accounting for clustering, twofold variation in screening by provider and clinic 
      remained (median odds ratio 1.97; intraclass correlation 0.13). CONCLUSIONS: 
      Screening practices vary widely and are only partially explained by patient, 
      provider, and clinic factors available in the EHR. Clinical decision support and 
      system-level interventions are needed to optimize screening practices.
CI  - (c) 2020 by the American Diabetes Association.
FAU - Obinwa, Udoka
AU  - Obinwa U
AD  - School of Public Health, University of Texas Health Science Center at Houston, 
      Houston, TX.
FAU - Perez, Adriana
AU  - Perez A
AD  - School of Public Health, University of Texas Health Science Center at Houston, 
      Houston, TX.
FAU - Lingvay, Ildiko
AU  - Lingvay I
AUID- ORCID: 0000-0001-7006-7401
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center, 
      Dallas, TX.
AD  - Department of Population and Data Sciences, University of Texas Southwestern 
      Medical Center, Dallas, TX.
FAU - Meneghini, Luigi
AU  - Meneghini L
AUID- ORCID: 0000-0003-4539-2725
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center, 
      Dallas, TX.
AD  - Parkland Health & Hospital System, Dallas, TX.
FAU - Halm, Ethan A
AU  - Halm EA
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center, 
      Dallas, TX.
AD  - Department of Population and Data Sciences, University of Texas Southwestern 
      Medical Center, Dallas, TX.
FAU - Bowen, Michael E
AU  - Bowen ME
AUID- ORCID: 0000-0003-4089-1584
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center, 
      Dallas, TX michael.bowen@utsouthwestern.edu.
AD  - Department of Population and Data Sciences, University of Texas Southwestern 
      Medical Center, Dallas, TX.
LA  - eng
GR  - K23 DK104065/DK/NIDDK NIH HHS/United States
GR  - R24 HS022418/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20200305
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cohort Studies
MH  - Delivery of Health Care, Integrated/*methods/standards
MH  - Diabetes Mellitus/*diagnosis
MH  - Female
MH  - Guideline Adherence/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Mass Screening/*methods/organization & administration/statistics & numerical data
MH  - Middle Aged
MH  - *Practice Patterns, Physicians'/standards/statistics & numerical data
MH  - Prediabetic State/diagnosis
MH  - Preventive Health Services/*methods/organization & administration/standards
MH  - Primary Health Care/methods/organization & administration/standards
MH  - Retrospective Studies
MH  - United States
MH  - Young Adult
PMC - PMC7171943
EDAT- 2020/03/07 06:00
MHDA- 2021/03/06 06:00
PMCR- 2021/05/01
CRDT- 2020/03/07 06:00
PHST- 2019/08/12 00:00 [received]
PHST- 2020/02/09 00:00 [accepted]
PHST- 2020/03/07 06:00 [pubmed]
PHST- 2021/03/06 06:00 [medline]
PHST- 2020/03/07 06:00 [entrez]
PHST- 2021/05/01 00:00 [pmc-release]
AID - dc19-1622 [pii]
AID - 1622 [pii]
AID - 10.2337/dc19-1622 [doi]
PST - ppublish
SO  - Diabetes Care. 2020 May;43(5):1016-1024. doi: 10.2337/dc19-1622. Epub 2020 Mar 5.