Abstract
Purpose :
Integrated delivery networks (IDNs) improve care for complex diseases like diabetes mellitus (DM) by enhancing communication between specialists conducting diabetic eye examinations and primary care providers. In healthcare organizations with risk contracts, it is acknowledged that "leakage" out of the system undermines patient care, yet the extent of this impact remains insufficiently studied. This research utilizes claims data provided by accountable care organizations (ACOs) to explore the consequences of patients seeking care or receiving referrals outside of an IDN healthcare organization on the rate at which completed eye examinations is successfully relayed back to primary care providers in the network.
Methods :
A cross-sectional study involved 1,139 patients with DM across three ACOs, where the eye examination was reported as part of the Healthcare Effectiveness Data and Information Set (HEDIS) Diabetes Care bundle. We compared the completion of eye examinations documented in the electronic medical record (EMR) with claims paid in 2022. Patient characteristics, encompassing demographic, sociomedical, and biometric factors, were analyzed using multivariate logistic regression to investigate their associations with the likelihood of reported completion of an eye examination.
Results :
Among 675 patients with a documented eye care provider, 84% were within the IDN. Patients receiving care within the IDN had a higher rate of subsequent eye exam completion (90%) compared with those who received eye care outside of the IDN (78%, P < 0.001). Whereas all eye exams completed within the IDN were available in EMR, fewer than three-quarters of eye exams completed outside the IDN were successfully communicated back to primary care providers and documented in the EMR (74%, P < 0.001). Having a hemoglobin A1c > 9.0%, indicating poor control, was the only additional factor associated with a lower likelihood that an eye exam was successfully conveyed back to primary care providers in the network (adjusted odds ratio [aOR], 0.390; 95% CI, 0.157 - 0.971, P = 0.042).
Conclusions :
IDNs facilitate comprehensive diabetes care, in part through a shared EMR. Ophthalmologists practicing outside of IDNs should enhance efforts to communicate diabetic eye examination results back to primary care providers, particularly for patients at risk of complications from poorly controlled DM.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.