Abstract
Purpose :
Most claims-based studies analyzing factors related to diabetic eye screening adherence have used single-payor databases, such as Medicare or managed care networks, and have focused on patient-level factors. In this study, we used a unique, all-payor database covering over 75% of Wisconsin residents (Wisconsin All-Payer Claims Database) to assess variability in screening rates across health systems and to identify health-system factors associated with screening.
Methods :
We included adults with diabetes (18-75 years old) who had claims billed throughout the baseline (10/1/2012 - 9/30/2013) and measurement years (10/1/2013 – 9/30/2014). We excluded patients cared for by a primary care provider with fewer than 20 patients in our dataset. We performed chi-square tests and used multivariate logistic regression models to assess potential predictors of diabetic eye screening based on health system factors, patient demographics, comorbidities, and adherence with hemoglobin A1c and LDL screening guidelines.
Results :
A total of 119,347 adults with diabetes from 143 Wisconsin health systems and 2,178 primary care providers met our inclusion criteria. Screening rates varied widely between health systems (31.8%-73.0%), with smaller health systems having lower screening rates. A patient’s health system had substantial predictive power regarding whether a patient received diabetic eye screening (chi-square 1840.4, p<0.001). In the multivariate analysis, when we excluded health system to focus on patient-level factors, patients from health systems based in small rural towns were more likely to obtain eye screening compared to patients from urban health systems (OR 1.13, 95% CI 1.08, 1.18, respectively). However, the directionality of the association reversed when health system was included in the model, with patients from health systems based in small rural towns being less likely to obtain eye screening compared to patients from urban health systems (OR 0.90, 95% CI 0.84, 0.95, respectively).
Conclusions :
In this state-wide, all-payor claims database, we found significant variability in diabetic eye screening rates across health systems. Health system was a major predictor of screening adherence, with a lower likelihood of screening among patients from smaller and rural health systems. Interventions directed at the health system may be important for increasing diabetic eye screening rates.
This is a 2021 ARVO Annual Meeting abstract.