Article Figures & Data
Tables
OCHIN HCN Providers 898 114 Patients 63,906 9422 Poor glucose control (HbA1c greater than 9.0) 14,021 (21.9%) 2374 (25.2%) Female 35,675 (55.8%) 5385 (57.2%) Age 12 to 21 347 (0.5%) 50 (0.5%) 22 to 49 19,831 (31.0%) 2839 (30.1%) 50 to 64 30,152 (47.2%) 5271 (55.9%) 64 or older 13,576 (21.2%) 1262 (13.4%) Charlson Comorbidity Index less than 2 31,554 (49.4%) 6625 (70.3%) 2 to 3 21,852 (34.2%) 2073 (22.0%) 4 to 5 7742 (12.1%) 375 (4.0%) 6 or higher 2758 (4.3%) 349 (3.7%) Mental and Behavioral Health Diagnoses 0 45,107 (70.6%) 6915 (73.4%) 1 16,582 (26.0%) 2019 (21.4%) >1 2217 (3.5%) 488 (5.2%) Median SDI Score (25th percentile, 75th percentile) 79 (55, 92) 80 (63, 91) HBA1c, hemoglobin A1c; SDI, Social Deprivation Index; OCHIN, Oregon Community Health Information Network; HCN, Health Choice Network.
- Table 2.
Association of Clinical and Social Complexity with Odds of Poor Glucose Control in Diabetic Patients
Tested Diabetes Cohort
Odds Ratio for Poor Glucose Control
(95% CI)OCHIN
N = 63,906HCN
N = 9422Charlson Comorbidity Index: 0 to 1 Referent Referent Charlson Comorbidity Index: 2 to 3 0.99 (0.94 to 1.03) 0.99 (0.88 to 1.11) Charlson Comorbidity Index: 4 to 5 1.19 (1.12 to 1.27)* 1.14 (0.89 to 1.45) Charlson Comorbidity Index: 6+ 1.12 (1.01 to 1.24)* 0.87 (0.67 to 1.13) Mental/Behavioral Health Diagnoses: 0 Referent Referent Mental/Behavioral Health Diagnoses: 1 0.91 (0.87 to 0.96)* 1.09 (0.97 to 1.22) Mental/Behavioral Health Diagnoses: more than 1 0.81 (0.73 to 0.90)* 0.97 (0.78 to 1.20) Social Deprivation Index† 1.05 (1.04 to 1.06)* 1.03 (1.01 to 1.06)* Results of full logistic regression model of the odds of poor diabetes control, controlling for age, gender, Charlson Comorbidity Index category, number of mental and behavioral health diagnoses and Social Deprivation Index (SDI) score of the patient's census tract (OCHIN) or zip code tabulation area (HCN). SDI scores were calculated using national percentile ranks of the SDI. Diabetic patients were defined as those with at least one HbA1c measurement in 2015. Poor control was defined as HbA1c > 9 at the last test in 2015.
↵* Significant at the .05 level.
↵† Odds ratio for an increase of 1 unit (10 national percentile ranks) in score.
CI, confidence interval; OCHIN, Oregon Community Health Information Network; HCN, Health Choice Network.
- Table 3.
Estimated Effect of Adjustment for Clinical and Social Complexity on Provider Quality Metrics
Poor Glucose Control in Diabetics OCHIN HCN Number of Providers 898 114 Providers with improved performance assessment after adding adjustment for Charlson Index to adjustment for age and sex 1 to 2 percentage point improvement 227 (25.3%) 66 (57.9%) 2 to 5 percentage point improvement 616 (68.6%) 33 (28.9%) Greater than 5 percentage point improvement 13 (1.4%) 1 (0.9%) Providers with improved performance assessment after adding adjustment for Mental and Behavioral Health Score to adjustment for age, sex and Charlson Index 1 to 2 percentage point improvement 0 0 2 to 5 percentage point improvement 0 0 Greater than 5 percentage point improvement 0 0 Difference in provider metric due to adding adjustment for SDI score to age, sex, Charlson Index and MHBH Score 1 to 2 percentage point improvement 113 (12.6%) 6 (5.3%) 2 to 5 percentage point improvement 25 (2.8%) 2 (1.8%) Greater than 5 percentage point improvement 0 0 Difference in provider metric due to adding adjustment to the median National SDI score to adjustment for age, sex, Charlson Index and MHBH Score 1 to 2 percentage point improvement 213 (23.7%) 49 (43.0%) 2 to 5 percentage point improvement 421 (46.9%) 34 (29.8%) Greater than 5 percentage point improvement 54 (6.0%) 3 (2.6%) Following the CMS procedure for adjustment of Performance Metrics for panel clinical complexity, provider quality metrics were adjusted for providers with more than 20 patients with the outcome.
OCHIN, Oregon Community Health Information Network; HCN, Health Choice Network; MHBH, Mental/Behavioral Health Diagnoses; SDI, Social Deprivation Index.
Psychosis or bipolar disorder ICD-9 diagnosis codes: 295, 295.0, 295.00, 295.01, 295.02, 295.03, 295.04, 295.05, 295.1, 295.1, 295.11, 295.12, 295.13, 295.14, 295.15, 295.2, 295.20, 295.21, 295.22, 295.23, 295.24, 295.25, 295.3, 295.30, 295.31, 295.32, 295.33, 295.34, 295.35, 295.4, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 295.5, 295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.6, 295.60, 295.61, 295.62, 295.63, 295.64, 295.65, 295.7, 295.70, 295.71, 295.72, 295.73, 295.74, 295.75, 295.8, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 295.9, 295.90, 295.91, 295.92, 295.93, 295.94, 295.95, 296.0, 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.1, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.4, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.46, 296.5, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.56, 296.6, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.66, 296.7, 296.8, 296.80, 296.81, 296.89, 297.0, 297.1, 297.2, 297.3, 301.22, V11.0 ICD-10 diagnosis codes: F20, F20.0, F20.1, F20.2, F20.3, F20.5, F20.8, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25, F25.0, F25.1, F25.8, F25.9, F28, F29, F30, F30.1, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31, F31.0, F31.1, F31.10, F31.11, F31.12, F31.13, F31.2, F31.3, F31.30, F31.31, F31.32, F31.4, F31.5, F31.6, F31.60, F31.61, F31.62, F31.63, F31.64, F31.7, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.8, F31.81, F31.89, F31.9 Substance abuse ICD-9 diagnosis codes: 291, 291.0, 291.1, 291.2, 291.3, 291.4, 291.5, 291.8, 291.81, 291.82, 291.89, 291.9, 292.0, 292.1, 292.11, 292.12, 292.2, 292.8, 292.81, 292.82, 292.83, 292.84, 292.85, 292.89, 292.9, 303, 303.0, 303.00, 303.01, 303.02, 303.03, 303.9, 303.90, 303.91, 303.92, 303.93, 304, 304.0, 304.00, 304.01, 304.02, 304.03, 304.1, 304.10, 304.11, 304.12, 304.13, 304.2, 304.20, 304.21, 304.22, 304.23, 304.3, 304.30, 304.31, 304.32, 304.33, 304.4, 304.40, 304.41, 304.42, 304.43, 304.5, 304.50, 304.51, 304.52, 304.53, 304.6, 304.60, 304.61, 304.62, 304.63, 304.7, 304.70, 304.71, 304.72, 304.73, 304.8, 304.80, 304.81, 304.82, 304.83, 304.9, 304.90, 304.91, 304.92, 304.93, 305, 305.0, 305.00, 305.01, 305.02305.03, 305.1, 305.2, 305.20, 305.21, 305.22, 305.23, 305.3, 305.30, 305.31, 305.32, 305.33, 305.4, 305.40, 305.41, 305.42, 305.43, 305.5, 305.50, 305.51, 305.52, 305.53, 305.6, 305.60, 305.61, 305.62, 305.63, 305.7, 305.70, 305.71, 305.72, 305.73, 305.8, 305.80, 305.81, 305.82, 305.83, 305.9, 305.90, 305.91, 305.92, 305.93 ICD-10 diagnosis codes: F10.2, F10.20, F10.21, F10.22, F10.220, F10.221, F10.229, F10.23, F10.230, F10.231, F10.232, F10.239, F10.24, F10.25, F10.250, F10.251, F10.259, F10.26, F10.27, F10.28, F10.280, F10.281, F10.282, F10.288, F10.29, F11.2, F11.20, F11.21, F11.22, F11.220, F11.221, F11.222, F11.229, F11.23, F11.24, F11.25, F11.250, F11.251, F11.259, F11.28, F11.281, F11.282, F11.288, F11.29, F13.2, F13.20, F13.21, F13.22, F13.220, F13.221, F13.229, F13.23, F13.230, F13.231, F13.232, F13.239, F13.24, F13.25, F13.250, F13.251, F13.259, F13.26, F13.27, F13.28, F13.280, F13.281, F13.282, F13.288, F13.29, F14.2, F14.20, F14.21, F14.22, F14.220, F14.221, F14.222, F14.229, F14.23, F14.24, F14.25, F14.250, F14.251, F14.259, F14.28, F14.280, F14.281, F14.282, F14.288, F14.29, F15.20, F18.10, F18.12, F18.120, F18.121, F18.129, F18.14, F18.15, F18.150, F18.151, F18.159, F18.17, F18.18, F18.180, F18.188, F18.19, F18.2, F18.20, F18.21, F18.22, F18.220, F18.221, F18.229, F18.24, F18.25, F18.250, F18.251, F18.259, F18.27, F18.28, F18.280, F18.288, F18.29, F19.2, F19.20, F19.21, F19.22, F19.220, F19.221, F19.222, F19.229, F19.23, F19.230, F19.231, F19.232, F19.239, F19.24, F19.25, F19.250, F19.251, F19.259, F19.26, F19.27, F19.28, F19.280, F19.281, F19.282, F19.288, F19.29 Patients were classified as having a history of depression, psychosis or bipolar disorders, or substance abuse based on presence of the diagnosis codes in their electronic health records. they were then classified as having 0, 1, or more than one of these three types of conditions.
- Appendix 2:
Association of Clinical and Social Complexity with Glucose Control Outcomes in Diabetic Patients: Results of Stepwise Regression Models
Tested Diabetes Cohort
Odds Ratio for Poor Glucose Control
(95% CI)OCHIN (n = 63,906) HCN (n = 9422) Step 1 Model Step 2 Model Full Model Step 1 Model Step 2 Model Full Model Charlson Comorbidity Index: 0 to 1 Referent Referent Referent Referent Referent Referent Charlson Comorbidity Index: 2 to 3 0.96 (0.92 to 0.96) 0.98 (0.94 to 1.02) 0.99 (0.94 to 1.03) 0.99 (0.88 to 1.15) 0.99 (0.88 to 1.11) 0.99 (0.88 to 1.11) Charlson Comorbidity Index: 4 to 5 1.15 (1.08 to 1.22) 1.19 (1.11 to 1.26) 1.19 (1.12 to 1.27) 1.15 (0.90 to 1.46) 1.14 (0.90 to 1.45) 1.14 (0.89 to 1.45) Charlson Comorbidity Index: 6+ 1.06 (0.96 to 1.17) 1.11 (1.00 to 1.23) 1.12 (1.01 to 1.24) 0.89 (0.69 to 1.15) 0.89 (0.68 to 1.15) 0.87 (0.67 to 1.13) Mental/Behavioral Health Conditions: 0 Referent Referent Referent Referent Mental/Behavioral Health Conditions: 1 0.90 (0.86 to 0.94) 0.91 (0.87 to 0.96) 1.09 (0.97 to 1.22) 1.09 (0.97 to 1.22) Mental/Behavioral Health Conditionss: more than 1 0.79 (0.71 to 0.88) 0.81 (0.73 to 0.90) 0.98 (0.79 to 1.22) 0.97 (0.78 to 1.20) Social Deprivation Indexs (Increase of 10 percentile ranks) 1.05 (1.04 to 1.06) 1.03 (1.01 to 1.06) Full results from stepwise logistic regression model of the odds of poor diabetes control, controlling for age, gender, Charlson Comorbidity Index category, number of mental and behavioral health diagnoses and social deprivation index (SDI) score of the patients neighborhood. SDI scores were calculated using national percentile ranks of the SDI Index. Diabetic patients were defined as those with at least one HbA1c measurement in 2015. Poor control was defined as HbA1c > 9 at the last test in 2015.
CI, confidence interval; OCHIN, Oregon Community Health Information Network; HCN, Health Choice Network.
