Faculty Collaboration Database

Estimating physician effects on glycemic control in the treatment of diabetes: methods, effects sizes, and implications for treatment policy. Diabetes Care 2008 May;31(5):869-73

Date

02/21/2008

Pubmed ID

18285552

DOI

10.2337/dc07-1662

Scopus ID

2-s2.0-42449151832 (requires institutional sign-in at Scopus site)   50 Citations

Abstract

OBJECTIVE: Researchers have only just begun to investigate physician-related effects on medical outcomes. Such research is necessary for developing empirically informed practice guidelines and policy. The primary goal of this study was to investigate whether glucose management in type 2 diabetes varies by randomly assigned physicians over the course of a year in treatment. A second goal of the study was to investigate whether physician-related effects vary across differential patient characteristics. A tertiary goal was to investigate potential patient-level effects on glucose management.

RESEARCH DESIGN AND METHODS: Hierarchical linear models were used to investigate A1C among 1,381 patients, nested within 42 randomly assigned primary care physicians at a Veterans Affairs medical center in the southeastern U.S. The primary outcome measure was change in A1C over the course of 1 year in treatment. On average, each study physician had 33 patients with diabetes.

RESULTS: Overall, physician-related factors were associated with statistically significant but modest variability in A1C change (2%), whereas patient-level factors accounted for the majority of variation in A1C change (98%). Physician effects varied by patient characteristics, mattering more for black patients, patients aged 65 years, and patients whose glucose management improved over the treatment year.

CONCLUSIONS: The results of this study indicate that differential physician effects have minimal impact on glycemic control. Results suggest that it is logical to support policies encouraging the development of patient-level behavioral interventions because that is the level that accounts for the majority of variance in glycemic control.

Author List

Tuerk PW, Mueller M, Egede LE

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Attitude to Health
Blood Glucose
Cohort Studies
Diabetes Mellitus
Female
Hospitals, Veterans
Humans
Male
Middle Aged
Physician-Patient Relations
Physicians, Family
Southeastern United States
United States