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A study of insurance coverage and diabetes outcomes in two care models
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A study of insurance coverage and diabetes outcomes in two care models
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http://www.ohsu.edu/xd/education/library/services/theses-dissertations/rights-statement.cfm
Title
A
study
of
insurance
coverage
and
diabetes
outcomes
in
two
care
models
Creator.PersonalName
Moore
,
Amber
Thesis.Degree
M.P.H.
Thesis.Major
Public Health
Thesis.DateDegreeAwarded
March
2009
Institution
Oregon Health & Science University
School
School of Medicine
Department
Dept. of Public Health and Preventive Medicine
Thesis.Advisor/Mentor
Michael, Yvonne L.
Bowen, Judith L.
Thesis.Committee
Kraemer, Dale F.
Subject.MeSH
Diabetes Mellitus
Insurance Coverage
Patient Care Management
Chronic Disease
Blood Glucose
Call Number
Q171 M821 2009
Description.Abstract
Background
:
Diabetes
is
one
of the
most
clinically
burdensome
and
financially
costly
chronic
diseases
in the
United
States
. To
date
,
medical
management
of this
condition
has been
largely
unsuccessful
; the
majority
of
people
with
diabetes
have
poorly
controlled
disease
,
resulting
in
avoidable
complications
and
cost
.
Additionally
,
individuals
with
public
insurance
may
be
disproportionately
affected
by the
complications
of
diabetes
compared
to
individuals
with
private
insurance
coverage
. The
chronic
illness
management
(CIM)
model
of
care
has been
shown
to
improve
clinical
outcomes
for
people
with
diabetes
compared
to a
traditional
general
internal
medicine
(GIM)
model
of
care
.
However
,
it
is
currently
unknown
if the
CIM
model
provides
equal
benefit
to
publically
and
privately
insured
individuals
.
Objectives
: This
goal
of this
study
was
two-fold
.
First
, the
relationship
between
insurance
status
(public
or
private)
and
blood
glucose
(measured
by
HbA1c)
was
examined
.
Second
,
insurance
status
was
studied
to
determine
if
individuals
with
one
type
of
insurance
derive
greater
benefit
from the
CIM
model
compared
to the
GIM
model
of
care
.
Methods
: This
study
utilized
a
database
derived
from
clinical
records
of
662
patients
with
diabetes
receiving
care
in a
CIM
specialty
clinic
or a
GIM
practice
within
an
academic
medical
center
between
July
2005
and
January
2008
. A
retrospective
cohort
design
was
used
to
examine
the
effects
of
insurance
status
and
care
model
on
HbA1c
outcomes
over
335
days
of
follow-up
, on
average
.
Both
logistic
and
linear
regression
analyses
were
conducted
to
examine
the
dependent
variable
as
both
a
continuous
and
categorical
outcome
,
adjusting
for
potential
confounders
. An
interaction
term
was
utilized
in the
model
to
determine
if the
care
model
influences
the
relationship
between
insurance
type
and
HbA1c
outcomes
.
Results
: There were
no
independent
or
joint
associations
between
median
HbA1c
during
follow-up
and
insurance
type
or
model
of
care
. The
odds
of
ever
achieving
glucose
control
during
the
follow
up
period
was
62%
less
in
privately
insured
individuals
compared
to
publically
insured
individuals
(p
<0.001)
,
however
this
relationship
was not
modified
by the
model
of
care
delivery
(p
for
interaction=0.229)
.
Conclusion
: The
publically
insured
group
had
better
glucose
control
than the
privately
insured
group
. There was
no
difference
in
HbA1c
outcomes
between
the
two
care
models
, and
individuals
with
public
and
private
insurance
derived
equal
benefit
from
both
care
models
.
Language
eng
Type
Text
Format.Use
Needs Adobe Acrobat to view
Format.FileSize
652594 Bytes
OCLC number
393067589
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