Article Figures & Data
Figures
- Figure 1.
Unadjusted rates of treatment intensification by vignette characteristics at 2 glycohemoglobin levels. *P < .05; **P < .01. CABG, coronary artery bypass graft; HbA1c, glycohemoglobin; IADL, instrumental activities of daily living.
- Figure 2.
Predicted probability of treatment intensification for the healthiest and most complex cases presented in the vignettes, overall and at 2 glycohemoglobin levels. The graph shows the predicted probability of treatment intensification for a 65-year-old with short disease duration, no cognitive impairment, and no heart disease (healthiest vignette patient) compared with that for an 80-year-old with long-standing diabetes, cognitive impairment with impaired instrumental activities of daily living, and heart disease with previous bypass graft (most complex vignette). Marginal effects were estimated holding physician-level factors (longer than average visit length, ≥75% of practice comprising Medicare patients, completed education in the past 5 years, clinician type, and state where the physician practices). HbA1c, glycohemoglobin.
Tables
- Table 1.
Description of Patient Characteristics Systematically Varied in Factorial Vignettes
Vignette Factor Level 1 (Healthy)* Level 2 (Complex/Intermediate Health)* HbA1c 7.5% 8.5% Age/disease duration 65 years old 80 years old Type 2 diabetes for 5 years Type 2 diabetes for 15 years Presence of cognitive impairment No information Some recent memory loss on formal testing She lives independently but depends on her eldest daughter to keep her medical appointments and pay her bills She stopped driving, in part because she occasionally got lost History of heart disease No history of cardiovascular disease Coronary artery disease, for which she underwent a coronary artery bypass graft 5 years ago ↵* The American Diabetes Association recommends glycated hemoglobin (HbA1c) targets <7.5% for older adults with few comorbid conditions and intact cognitive and physical functioning (healthy), and targets <8% for older adults with comorbid chronic diseases, impaired instrumental activities of daily living, or mild to moderate cognitive impairment (complex/intermediate).
Total Sample (N = 336) Family Medicine Physicians (n = 108) Internal Medicine Physicians (n = 73) Nurse Practitioners (n = 155) Year professional education completed, median (range) 1996 (1955–2015) 1991 (1968–2015) 1986 (1955–2011) 2003 (1978–2015) Duration of routine visit (minutes), mean (range) 23 (5–90) 21 (7–45) 22 (5–90) 24 (5–60) Medicare patients among total practice <25 28 39 16 25 25–75 52 50 64 48 >75 20 11 19 26 State where respondents practiced Florida 52 22 49 73 Minnesota 25 50 40 1 Other 23 28 11 26 Patients sampled from licensure lists 76 72 89 74 Data are percentages unless otherwise indicated.
Model 1: Patient Characteristics Model 2: Patient and Clinician Characteristics Model 3: Patient, Clinician, and State Characteristics Patient characteristics 8.5% HbA1c 31.7* (2.1) 31.7* (2.1) 31.6* (2.1) 80 years old −20.8* (2.0) −20.9* (2.0) −20.9* (1.9) Heart disease 3.0 (1.9) 3.0 (1.9) 3.0 (1.9) Cognitive impairment −10.6* (1.9) −10.6* (1.9) −10.6* (1.9) Clinician characteristics Clinician type (reference = family medicine) Internal medicine 11.1* (3.6) 8.1† (3.7) Nurse practitioner 13.8* (3.5) 7.5† (3.8) Longer than average visit (>20 minutes) −0.8 (3.3) 1.1 (3.3) Majority (>75%) of practice comprises Medicare patients −1.0 (3.8) −3.4 (3.8) Recently completed education (within 5 years) 6.0 (3.3) 6.3† (3.2) Practice in Florida 13.7* (3.2) Model intraclass correlation 0.63 0.60 0.59
