| Primary Author: | Christopher R. Mattson, MD |
| Co-Principal Investigators/Collaborators: | Jorge Martinez, MD, Koko Aungo, MD, MPH, FACP, Raul Rivera, MD, FACP, Ishak A. Mansi, MD, FACP |
| Organization | San Antonio Military Medical Center (SAMMC) |
Abstract
Purpose
To compare compliance with quality measures of diabetic care in the internal medicine clinic in SAMMC among active duty military physicians, marked by a lack of continuity of care, mid-level providers, marked by having an independent panel of patients, and civilian physicians.
Background
The practice model in the internal medicine clinic at San Antonio Military Medical Center (SAMMC) is different from its civilian counterparts. Outpatient care is provided by 4 teams of providers; each consists of active duty military physicians, mid-level providers (Physician Assistants and Nurse Practitioners), and civilian physicians. Each member of the team is responsible for a panel of patients. When military physicians deploy, their team members assume care of their patients until their return, risking fragmentation of care. Additionally, mid-level providers carry their own panel of patients, which they manage under indirect supervision of assigned physicians.
Materials & Methods
A retrospective study (years 2009 and 2010), that compared compliance with quality measures of diabetic care among provider groups: active duty military physicians, mid-level providers, and civilian physicians. The quality measures utilized were proportion of diabetic patients in whom HbA1c was measured, proportion of patients with HbA1c at goal, and proportion of patients with LDL-Cholesterol <100mg/dL.
Results
Data were collected on 1885 diabetic patients through 2009 and 2010. Although the mean (±SD) number of diabetic patients cared for by active duty military physicians, mid-level providers, and civilian physicians varied significantly (19.4±10.7, 104.1±28.8, 53.7±50.4, p=0.002); there were no significant differences in the proportion of patients with measured HbA1c (84.7±10.1, 88.8±4.4, 89.6±7.4, p= 0.7); the proportion of HbA1c at goal (75.9±8.7, 80.0±4.9, 79.2±10.5, p=0.7); and the proportion of LDL-cholesterol <100mg/dL (72.6±7.3, 70.3±2.4, 69.6±13, p=0.8); respectively.
Conclusion
Despite the differences in mean patient numbers among providers, quality measures of diabetic care were similar. Using this model, military physicians have successfully deployed without evidence of a decline in care for their diabetic patients. Further study is warranted for this unique model of practice.
Bibliography
1) Internal Medicine Service, Department of Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
2) University of Texas Health Science Center at San Antonio.
Disclaimer
The views expressed herein are those of the authors and do not reflect the official policy or position of San Antonio Military Medical Center, the U.S. Army Medical Department, the U.S. Army Office of The Surgeon General, the Department of the Army, Department of Defense or the U.S. Government.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).