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Research ArticleOriginal Research

Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study

Young-Rock Hong, Jinhai Huo, Ara Jo, Michelle Cardel and Arch G. Mainous
The Journal of the American Board of Family Medicine November 2020, 33 (6) 903-912; DOI: https://doi.org/10.3122/jabfm.2020.06.200217
Young-Rock Hong
From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (YRH, JH, AJ, AGM); Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (MC); Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM).
PhD, MPH
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Jinhai Huo
From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (YRH, JH, AJ, AGM); Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (MC); Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM).
PhD, MD, MSPH
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Ara Jo
From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (YRH, JH, AJ, AGM); Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (MC); Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM).
PhD, MS
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Michelle Cardel
From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (YRH, JH, AJ, AGM); Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (MC); Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM).
PhD, MS, RD
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Arch G. Mainous III
From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (YRH, JH, AJ, AGM); Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (MC); Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM).
PhD
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    Figure 1.

    Analytic cohort selection. Abbreviation: MEPS, Longitudinal Medical Expenditure Panel Survey.

Tables

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    Table 1.

    Baseline Characteristics of Study Population by Teach-Back Experience

    Teach-BackNon-Teach-Back
    No.% (95% CI)*No.% (95% CI)*P-Value
    Age group, years
     18 to 4918621.8 (18.2 to 25.3)44219.5 (17.3 to 21.6).602
     50 to 5921726.4 (22.4 to 30.3)56424.3 (21.8 to 26.9)
     60 to 6412115.4 (12.2 to 18.6)32316.0 (13.8 to 18.1)
     65 to 6911012.8 (10.1 to 15.4)26914.0 (11.8 to 16.2)
     70+17123.7 (19.1 to 28.3)49826.2 (23.4 to 29.0)
     Median age (IQR)59 (51 to 68)61 (51 to 59).354
    Sex.977
     Female44752.5 (48.6 to 56.5)115152.6 (49.9 to 55.4)
     Male35847.5 (43.5 to 51.4)94547.4 (44.6 to 50.1)
    Race/ethnicity<.001
     Non-Hispanic White23049.5 (44.6 to 54.4)82162.8 (59.5 to 66.1)
     Non-Hispanic Black24319.9 (16.9 to 23.0)52214.9 (12.6 to 17.1)
     Hispanic24519.0 (15.5 to 22.4)55114.2 (12.0 to 16.4)
     Other†8711.6 (8.2 to 15.0)2028.1 (6.3 to 10.0)
    Education.156
     Less than high school37740.5 (36.5 to 44.5)89536.0 (33.3 to 38.8)
     High school/GED18825.2 (20.9 to 29.4)51825.6 (22.9 to 28.3)
     Some college14419.4 (15.9 to 22.8)42123.8 (21.3 to 26.4)
     Bachelor’s or beyond9615.0 (11.7 to 18.2)26214.5 (12.3 to 16.7)
    Family income‡.803
     Poor23621.6 (17.8 to 25.4)58820.0 (17.6 to 22.5)
     Low income14916.4 (13.2 to 19.7)38115.5 (13.2 to 17.7)
     Middle income22829.2 (24.4 to 34.1)60831.2 (28.3 to 34.1)
     High income19232.7 (27.7 to 37.8)51933.3 (29.9 to 36.6)
    Marital status.569
     Not married38141.8 (37 to 46.6)99243.5 (40.5 to 46.5)
     Married42458.2 (53.4 to 63)110456.5 (53.5 to 59.5)
    Employment.721
     Not employed47955.4 (51.2 to 59.7)123056.4 (53.2 to 59.5)
     Employed32644.6 (40.3 to 48.8)86643.6 (40.5 to 46.8)
    Immigration status<.001
     No (born in the US)55277.2 (73.1 to 81.4)154484.4 (82.3 to 86.4)
     Yes: immigrant25322.8 (18.6 to 26.9)55215.6 (13.6 to 17.7)
    Perceived English proficiency.379
     Comfortable48663.7 (58.9 to 68.5)123061.3 (58.6 to 64.1)
     Not comfortable31936.3 (31.5 to 41.1)86638.7 (35.9 to 41.4)
    Census region, No. (%).606
     Northeast13016.2 (12.9 to 19.6)31515.6 (13.3 to 17.9)
     Midwest13520.9 (17.0 to 24.8)38223.5 (20.4 to 26.5)
     South32441.2 (36.6 to 45.7)88241.3 (38.1 to 44.5)
     West21621.7 (18.4 to 25.1)51719.6 (17.3 to 21.9)
    Health insurance, No. (%).252
     Private38656.7 (52.3 to 61.1)105460.1 (57.3 to 62.9)
     Public35137.6 (33.3 to 41.8)85233.8 (31.1 to 36.6)
     Uninsured685.7 (4.0 to 7.4)1906.1 (4.8-7.3)
    General health status.879
     Fair to poor32434.3 (30.3 to 38.2)83634.6 (31.9 to 37.3)
     Excellent to good48165.7 (61.8 to 69.7)125865.4 (62.7 to 68.1)
    Hearing handicap.104
     No problem70584.3 (81.2 to 87.5)186487.1 (84.9 to 89.3)
     Having a problem with hearing10015.7 (12.5 to 18.8)23212.9 (10.7 to 15.1)
    Current smoking.602
     No65984.7 (81.5 to 87.9)177285.6 (83.5 to 87.8)
     Yes13215.3 (12.1 to 18.5)29114.4 (12.2 to 16.5)
    Obesity (BMI ≥30 kg/m2).824
     No35943.9 (39.1 to 48.6)92043.3 (40.3 to 46.2)
     Yes43856.1 (51.4 to 60.9)114756.7 (53.8 to 59.7)
    Hypertension.822
     No18824.5 (20.7 to 28.3)48924.1 (21.5 to 26.7)
     Yes61775.5 (71.7 to 79.3)160775.9 (73.3 to 78.5)
    Hyperlipidemia.136
     No25131.4 (27.2 to 35.5)59827.8 (25.3 to 30.3)
     Yes55468.6 (64.5 to 72.8)149872.2 (69.7 to 74.7)
    Asthma.919
     No68986.7 (83.7 to 89.7)181086.5 (84.7 to 88.3)
     Yes11613.3 (10.3 to 16.3)28613.5 (11.7 to 15.3)
    COPD.577
     No76094.2 (92.0 to 96.4)198393.4 (91.8 to 95.0)
     Yes455.8 (3.6 to 8.0)1136.6 (5.0 to 8.2)
    Time since diabetes diagnosis, years, Median (IQR)7 (3 to 13)7 (3 to 14).345
    DM care: lifestyle modifications.298
     No16718.9 (15.4 to 22.3)47421.2 (19.0 to 23.5)
     Yes63881.1 (77.7 to 84.6)162278.8 (76.5 to 81.0)
    DM care: antidiabetic medications.083
     No14017.5 (14.5 to 20.4)40220.9 (18.6 to 23.2)
     Yes66582.5 (79.6 to 85.5)169479.1 (76.8 to 81.4)
    DM care: insulin injections.717
     No56271.6 (67.4 to 75.8)149570.7 (68.2 to 73.3)
     Yes24328.4 (24.2 to 32.6)60129.3 (26.7 to 31.8)
    • Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; GED, general educational development; IQR, interquartile range; CI, confidence interval.

    • ↵* Estimates were weighted to be nationally representative using recommended stratification, clustering, and weighting by Agency for Healthcare Research and Quality.

    • ↵† Other includes non-Hispanic Asians/Pacific Islanders, Alaskan/American Natives, and other multiple races.

    • ↵‡ Family income level was defined based on Federal Poverty Level [FPL] < 100% as poor income, FPL 100%–200% as low income, FPL 200%–400% middle income, and FPL > 400% high income.

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    Table 2.

    Associations between Teach-Back Experience and Patient Health Outcomes

    Teach-Back
    YesNoTeach-Back versus Non-Teach-Back
    %, (95% CI)%, (95% CI)P-ValueCrude Odds Ratio (OR)P-ValueAdjusted OR*P-Value
    Complication
     Any14.0 (10.9 to 17.1)17.7 (15.8 to 19.7).0420.74 (0.56-0.99).0450.70 (0.52-0.96).026
     CVDs†6.7 (4.5 to 8.9)8.3 (6.7 to 9.8).2810.77 (0.50-1.19).2320.71 (0.45-1.11).133
     Kidney problem3.1 (1.4-4.7)4.9 (3.9-5.9).0520.63 (0.36-1.10).1020.62 (0.33-1.14).123
     Eye problem5.5 (3.6 to 7.5)7.1 (5.6 to 8.7).2000.77 (0.50-1.19).2420.76 (00.49-1.18).217
    Hospitalization
     All cause5.4 (3.6 to 7.2)7.8 (6.4 to 9.3).0510.73 (0.49-1.10).1330.72 (0.47-1.09).123
     DM specific2.0 (1.1 to 2.8)2.9 (1.8-4.0).0850.59 (0.30-1.17).1310.58 (0.29-1.14).112
     Complication related2.4 (1.2 to 3.7)4.6 (3.5-5.7).0110.53 (0.30-0.94).0310.51 (0.29-0.88).015
    • Abbreviations: CVD, cardiovascular disease; DM, diabetes mellitus.

    • ↵* Adjusted model included age, sex, race/ethnicity, foreign-born status, education, family, census, health insurance type, general health status, and current smoking, obesity, number of comorbid conditions, and current diabetes management items: whether having lifestyle modification, antidiabetic drugs, and insulin injections.

    • ↵† Includes coronary heart disease, angina, myocardial infarction, other heart diseases.

    • OR, odds ratio; CI, confidence interval.

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    Table 3.

    Differential Changes in Adjusted Total Medical Expenditure by Teach-Back Experience

    Teach-Back
    Total expenditure†YesNoTeach-Back versus Non-Teach-Back
    Mean (95% CI)Mean (95% CI)Difference*P-value
    Year 1 expenditure8162 (7790 to 8535)8435 (8173 to 8699)−36 (−176 to 105).615
    Year 2 expenditure1,0082 (9620 to 10544)1,2075 (11743 to 12406)−1616 (−1801 to −1430)<.001
    Changes between year 1 and year 21920 (1660 to 2178)3639 (3466 to 3812)−1579 (−1717 to −1443)<.001
    • ↵* Adjusted for age, sex, race/ethnicity, foreign-born status, education, family, census, health insurance type, general health status, and current smoking, obesity, number of comorbid conditions, and current diabetes management items: whether having lifestyle modification, antidiabetic drugs, and insulin injections.

    • ↵† Sum of direct payments for care provided during the year, including hospital inpatient care, ambulatory care, other medical services, and out-of-pocket payments.

    • CI, confidence interval.

    • View popup
    Table A-1.

    AHRQ Clinical Classification Category (CCC) and ICD-9 and 10-CM Codes Defining Medical Conditions

    CCC CodesConditionsAggregated ICD-9-CM CodesAggregated ICD-10-CM Codes
    Diabetes
    49Diabetes mellitus without complication24900 25000 2500 17902 79021 79022 79029 7915 7916V4585 V5391 V6546E089 E099 E109 E119 E139 R7301 R7302 R7303 R7309R739 R81 R824 Z4681 Z9641
    50Diabetes mellitus with complications24901 24910 24911 24920 24921 24930 24931 24940 24941 24950 24951 24960 24961 24970 24971 24980 24981 24990 24991 25002 25003 25010 25011 25012 25013 25020 25021 25022 25023 25030 25031 25032 25033 25040 25041 25042 25043 25050 25051 25052 25053 25060 25061 25062 25063 25070 25071 25072 25073 25080 25081 25082 25083 25090 25091 25092 25093E0800 E0801 E0810 E0811 E0821 E0822 E0829 E08311 E08319 E08321 E08331 E08341 E8535E0836 E0837 × 1 E0837 × 2E0837 × 3 E0837 × 9 E0839E0840 E0841 E0842 E0843E0844 E0849 E0851 E0852 E0859 E08610 E08618 E0862 E0863 E0864 E0865 E0869 E088 E0900 E0901 E0910 E0911 E0921 E0922 E0929 E0931 E0932 E09329 E09331 E09339 E09341 E09349 E09351 E093521 E093531 E09354 E09355 E09359 E093 6E0937 × 1 E0937 × 2 E0937 × 3E0937 × 9 E0939 E0940 E0941 E0942 E0943 E0944 E0949 E0951 E0952 E0959 E09610 E09618 E0962 E0963 E09641 E09649 E0965 E0969 E098 E1010 E1011 E1021 E1022 E1029 E1031 E1032 E1033 E1034 E1035 E1036 E1037 × 1 E1037 × 2 E1037 × 3 E1037 × 9E1039 E1040 E1041 E1042 E1043 E1044 E1049 E1051 E1052 E1059 E1061 E1062 E1063 E1064 E1065 E1069 E108 E110 E111 E112 E113 E1140 E1151 E1152 E1159E1161 E1162 E1163 E1164 E1169 E118 E1300 E1310 E1311 E1321 E1322 E1329 E1331 E1332 E1333 E13341 E13351 E13352 E13353 E13354 E13355 E13359 E1336 E1337 × 1 E1337 × 2 E1337 × 3E1337 × 9 E1339 E1340 E1341E1342 E1343 E1344 E1349 E1351 E1352 E1359 E13610 E13618 E1362 E1363 E13641E13649 E1365 E1369 E138 G3289
    51Other endocrine disorders2510 2511 2512 2513 2514 2515 2518 2519 2520 25200 25201 25202 25208 2521 2528 2529 2530 2531 2532 2533 2534 2535 2536 2537 2538 2539 2540 2541 2548 2549 2550 2551 25510 25511 25512 25513 25514 2552 2553 2554 25541 25542 2555 2556 2558 2559 2560 2561 2562 2563 2564 2568 2569 2570 2571 2572 2578 2579 2580 25801 2581 2588 2589 2590 2591 2592 2593 2594 2595 25950 25951 25952 2598 2599 7946E15 E160 E161 E162 E163 E164 E168 E169 E200 E208 E209 E210 E211 E212 E213 E214 E215 E220 E221 E222 E228 E229 E230 E231 E232E233E236E237 E240 E241 E242 E243 E244E248E249 E250 E258 E259 E260 E2602 E2609 E261 E2681 E2689 E269 E270 E271 E272 E273 E274 E2749 E275 E278 E279 E280 E281 E282 E288 E289 E290 E291E298 E299 E300 E301 E308 E309 E310 E311 E312 E318 E319 E320 E321 E328 E329 E340 E341 E342 E343 E344 E3450 E3451 E3452 E348 E349 E35 Z9483 Z9649
    53Disorders of lipid metabolism2720 2721 2722 2723 2724E780 E7800 E7801 E781 E782 E783 E784 E785
    Cardiovascular Diseases
    100Acute myocardial infarction4100 41000 41001 41002 4101 41010 41011 41012 4102 41020 41021 41022 4103 41030 41031 41032 4104 41040 41041 41042 4105 41050 41051 41052 4106 41060 41061 41062 4107 41070 41071 41072 4108 41080 41081 41082 4109 41090 41091 41092I2101 I2102 I2109 I2111 I2119 I2121 I2129 I213 I214I219 I21A1 I21A9 I220 I221 I222 I228 I229
    101Coronary atherosclerosis and other heart disease4110 4111 4118 41181 41189 4124130 4131 4139 4140 41400 41401 41406 4148 4149 V4581 V4582I200 I201 I208 I209 I237 I240 I241 I248 I249 I2510 I2511 I25111 I25118 I25119 I252 I255 I256 I2575 I25811 I2582 I2583 I2584 I2589 I259 Z951 Z955 Z9861
    102Nonspecific chest pain78650 78651 78659R072 R0782 R0789 R079
    103Pulmonary heart disease4150 4151 41512 41513 41519 4160 4161 4162 4168 4169 4170 4171 4178 4179I2601 I2602 I2609 I2690 I2692 I2699 I270 I271 I272 I2720 I2721 I2722 I2723 I2724 I2729 I2781 I2782 I2783 I2789 I279 I280 I281 I288 I289 Z86711
    104Other and ill-defined heart disease41410 41411 41412 41419 4291 4292 4293 4295 4296 42971 42979 42981 42982 42989 4299I231 I232 I233 I234 I235 I236 I238 I253 I2541 I2542 I510 I511 I512 I513 I515 I517 I5181 I5189 I519 I52
    105Conduction disorders4260 42610 42611 42612 42613 4262 4263 4264 42650 42651 42652 42653 42654 4266 4267 42681 42682 42689 4269 V450 V4500 V4501 V4502 V4509 V533 V5331 V5332 V5339I440 I441 I442 I4430 I4439 I444 I445 I4460 I4469 I447 I450 I4510 I4519 I452 I453 I454 I455 I456 I4581 I4589 I459 Z4501 Z45018 Z4502 Z4509 Z950 Z95810
    106Cardiac dysrhythmias4270 4271 4272 42731 42732 42760 42761 42769 42781 42789 4279 7850 7851I470 I471 I472 I479 I480 I481 I482 I483 I484 I4891 I4892 I491 I492 I493 I4940 I4949 I495 I498 I499 R000 R001R002
    107Cardiac arrest and ventricular fibrillation42741 42742 4275I462 I468 I469 I4901 I4902
    108Congestive heart failure; nonhypertensive398914280428142820 42821428224282342830 42831 428324283342840 4284142842428434289I0981 I501 I502' I5021 I5022 I5023I5 03' I5031 I5032 I5033 I504 I5041 I5042 I5043 I5081 I5082 I5083 I5084 I5089 I509
    109Acute cerebrovascular disease34660 34661 34662 34663 430 431 4320 4321 4329 43301 43311 43321 43331 43381 43391 4340 43400 43401 4341 43410 43411 4349 43490 43491 436G43601 G43609 G43611 G43619 I6000 I6001 I6002 I6010 I6011 I6012 I602 I6020 I6021I6022 I6030 I6031 I6032I604 I6050 I6051 I6052 I606 I607 I608 I609 I610 I611 I612 I613I614I615 I616 I618 I619 I6200 I6300 I6310 I6320 I6330 I6340 I6350 I636 I638 I639 I6601 I6602 I6603 I6609 I6611 I6612 I6613 I6619 I6621 I6622 I6623 I6629 I663 I668 I669 R297 R29710 R29720 R29730 R29740 R29741 R29742
    110Occlusion or stenosis of precerebral arteries4330 43300 4331 43310 4332 43320 4333 43330 4338 43380 4339 43390I6501I6502I6503I6509 I651I6521I6522I6523 I6529I658I659
    111Other and ill-defined cerebrovascular disease4370 4371 4373 4374 4375 4376 4377 4378 4379G460 G461 G462 G463 G464 G465 G466 G467 G468 I671 I672 I675 I676 I677 I6781 I6782 I6783 I67841 I67848 I6789 I679 I680 I682 I688
    112Transient cerebral ischemia4350 4351 4352 4353 4358 4359G450 G451 G452 G453 G454 G458 G459
    113Late effects of cerebrovascular disease438 4380 43810 43811 43812 43813 43814 4381 43820 43821 4382243830 43831 43832 43840 43841 43842 43850 43851 43852 43853 4386 4387 43881 43882 43883 43884 43885 43889 4389I6900 I6901 I69020 I69031 I69041 I69042 I69043 I69044 I69049 I69051 I69052 I69053 I69054 I69059 I69061 I69062 I69063 I69064 I69065 I69069 I69090 I69091 I69092 I69093 I69098 I6910 I6911 I6920 I6930 I6980 I6981 I69810 I6990I6991
    114Peripheral and visceral atherosclerosis4400 4401 4402 44020 44021 44022 44023 44029 4404 4408 4409 4439 5570 5571 5579I700 I701 I702 I708 I7090 I7091 I7092 I739 K550 K551 K558 K559
    115Aortic; peripheral; and visceral artery aneurysms4410 44100 44101 44102 44103 4411 4412 4413 4414 4415 4416 4417 4419 4420 4421 4422 4423 44281 44282 44283 44284 44289 4429 44321 44322 44323 44324 44329 44770 44771 44772 44773I670 I710 I720I721 I722 I723 I724 I725 I726 I728 I729 I777 I778 I790
    116Aortic and peripheral arterial embolism or thrombosis44409 44414 44214 4422 44481 44489 44494 4501 44502 44581 44589I7401 I7409 I7410 I7411 I7419 I742 I743 I744 I745 I748 I749 I7501 I75021 I75022 I75023 I75029 I7581 I7589
    117Other circulatory disease4430 4431 44381 44382 44389 4460 4461 4462 44620 44621 44629 4463 4464 4465 4466 4467 4470 4471 4472 4473 4474 4475 4476 4478 4479 4480 4481 4489 4580 45814588 4589 4590 45989 4599 785979430 79431 79439 7962 V125 V1250 V1253 V1254 V1259 V151 V421 V432 V4321 V4322 V434 V717I7300 I731 I7381 I7389 I770 I771 I772 I773 I774 I775 I776 I7789 I779 I780 I781 I788 I789 I791 I798 I950 I951 I9589 I959 I998 I999 M310 R030 R031 R0989 R58 Z8673 Z8674 Z8679 Z941 Z943 Z95811 Z95820 Z95828 Z959 Z9862
    118Phlebitis; thrombophlebitis and thromboembolism4510 45111 45119 4512 45181 45182 45183 45184 45189 4519 452 4530 4531 4532 4533 45340 45341 45342 45351 45352 4536 45371 45372 45373 45374 45375 45376 45377 45379 4538 45382 45386 45387 4539 V1251 V1252 V1255I8000 I801 I80201 I80202 I80203 I80209 I8021 I8022 I8023 I8029 I803 I808 I809I81 I820 I821 I82290 I82291 I823 I824 I824Y1I824Y2I824Y3 I824Y9 I824Z1I824Z2 I824Z3 824Z9 I82501 I82502 I82503 I82509 I82511 I82512 I82513 I82519 I82521 I82522 I82523 I82529 I82531 I82532 I82533 I82539 I82541 I82542 I82543 I82549 I82591 I82592 I82593 I82599 I825Y1 I825Y2 I825Y3 I825Y9 I825Z1I825Z2 I825Z3 I825Z9 I82601 I82602 I82603 I82609 I82611 I82612 I82613 I82619 I82621 I82622 I82623 I82629 I82701 I82702 I82703 I82709 I82711 I82712 I82713 I82719 I82721 I82722 I82723 I82729 I82811 I82812 I82813 I82819 I82890 I82891 I8290 I8291 I82A11 I82A12 I82A13 I82A19 I82A21 I82A22 I82A23 I82A29I82B11 I82B12 I82B13 I82B19 I82B21 I82B22 I82B23 I82B29 I82C11 I82C12 I82C13 I82C19 I82C21 I82C22 I82C23 I82C29 Z86718 Z8672
    Kidney Problem
    158Chronic renal failure585 5853 5854 5855 5856 5859 7925 V420 V451 V560 V561 V562 V5631 V5632 V568N181 N182 N183 N184 N185 N186 N189 R880 Z4901 Z4902 Z4931 Z4932 Z9115 Z940 Z992
    Eye Problem
    87Retinal detachments; defects; vascular occlusion; and retinopathy36100 36101 36102 36103 36104 36105 36106 36107 36110 36111 36112 36113 36114 36119 3612 36130 36131 36132 36133 36181 36189 3619 3620136202 36203 36204 36205 36206 36207 36210 36211 36212 36213 36214 36215 36216 36217 36218 36221 36229 36230 36231 36232 36233 36234 36235 36236 36237 36240 362413624236243 36250362513625236253 36254 36255 36256 36257 36260 3626136262 36263 36264 36265 36266 36270 36271 36272 36273 36274 36275 36276 36277 36281 36282 36283 36284 36285 36289 3629H330 H331 H3320 H3330 H3340 H338 H3400 H3401 H3402 H3403 H341 H34210 H34811 H34821 H34831 H34831 H34832 H34833 H34839 H349 H350 H3510 H3511 H3512 H3513 H3514 H3515 H35161 H35171 H3520 H3521 H3522 H3523 H3530 H3531 H3532 H3534 H3535 H3536 H3537 H3538 H3540 H3541 H3542 H3543 H3545 H3546 H3550 H3551 H3552 H3553 H3554 H3560 H3561 H3562 H3563 H3570 H3571 H3572 H3573 H3581 H3582 H3589 H359 H36
    Nerve system disorder
    95Other nervous system disorders325 3321 33720 33721 33722 33729 3410 3411 3418 3419 34461 347 34700 34701 34710 34711 3480 3482 3483 34830 34831 34839 3484 3485 3488 3489 3492 34981 34982 34989 34993501 3502 3508 3509 35103511 3518 3519 3520 3521 3522 3523 3524 3525 3526 3529 35303531 3532 3533 3534 3535 3536 3538 3539 3540 3541 3542 3543 3544 3545 3548 3549 3550 3551 3552 3553 3554 3555 3556 3557 35571 35579 3558 3559 3560 3561 3562 3563 3564 3568 35693 570 3571 3572 3573 3574 3575 3576 3577 3578 35781 35782 35789 3579 3580 35800 35801 3581 3582 3588 3589 3590 3591 3592 3593 3594 3595 3596 3598 35981 35989 3599 7810 7811 7812 7813 7817 78187820 7843 7845 78460 78461 78469 7920 7930 79400 79401 79402 79409 7941079411 79412 79413 79414 79415 79416 79417 79419 7961 V124 V1240 V1241 V1242 V1249 V415 V452 V484 V485 V493 V530 V5301 V5302 V5309B2701 B2711 B2781 B2791 G08 G130 G131 G132 G138 G210 G2111 G2119 G212 G213 G214 G218 G219 G360 G361 G368 G369 G370 G371 G372 G373 G374 G375 G378 G379 G4720 G4721 G4722 G4723 G4724 G4725 G4726 G4727 G4729 G474 G4763 G500 G501 G508 G509 G510 G511 G512 G513 G514 G518 G519 G520 G521 G522 G523 G527 G528 G529 G53 G540 G541G542 G543 G544 G545 G546 G547 G548 G549 G55 G560 G561 G562 G563 G564 G568 G569 G570 G571 G572 G573 G574 G575 G576 G577 G578 G579 G580 G587 G588 G589 G59 G600 G601 G602 G603 G608 G609 G610 G611 G6181 G6182 G6189 G619 G620 G622 G6281 G6282 G6289 G629 G63G64 G650 G651 G652 G7000 G7001 G701 G70 G7080 G7081 G7089 G709 G710 G711 G712 G713 G718 G719 G720 G721 G722 G723 G7241 G7249 G7281 G7289 G729G731 G733 G737 G890 G8911 G8912 G8918 G8921 G8922 G8928 G8929 G893G894 G902 G9050 G9051 G90521 G90522 G90523 G90529 G9059 G908 G909' G910 G911 G912 G913 G914 G918 G919 G92 G930 G932 G9340 G9341 G9349 G935' G936 G937 G9381 G9382 G9389 G939 G94 G950 G9511 G9519 G9520 G9529 G9581 G9589 G959 G960 G9612 G9619 G968 G969 G980 G988 G998 J1081 R200 R201 R202 R203 R208 R209 R250 R251 R253 R258 R259 R260 R261 R262 R2681 R2689 R269 R270 R278 R279 R290 R292 R414 R41840 R41841 R41842 R41843 R41844 R4189 R430R431 R432 R438 R439 R4701 R4702 R471 R4781 R4782 R4789 R479 R481 R482 R488 R489 R900 R9082 Z462 Z86011 Z8661 Z8669 Z982
    • Based on Clinical Classification Software-DIAGNOSES, January 1980 through September 2018.

    • ICD, International Classification of Diseases.

    • View popup
    Table A-1.

    Descriptions of Study Variables

    DomainVariableTypeDefinitionData Source
    Teach-Back ExperienceMedical instructionBinaryDoctors or other health providers gave instructions that were easy to understandMEPS-Household Component: CAHPS®
    Teach-BackBinaryDoctors or other health providers asked to describe how to follow the medical instruction given.MEPS-Household Component: CAHPS®
    Patient characteristics: SocioeconomicAge, yearsCategoricalAge when first entered MEPSMEPS-Household Component
    SexCategoricalGender of respondents during MEPS interviewMEPS-Household Component
    Race/EthnicityCategoricalRace/ethnic backgroundMEPS-Household Component
    EducationCategoricalHighest degree of education attained at the time of interviewMEPS-Household Component
    Family IncomeCategoricalFamily income as a percentage of povertyMEPS-Household Component
    Marital StatusBinary (Yes or No)Current marital status at the time of interviewMEPS-Household Component
    EmploymentBinaryCurrent employment status at the time of interviewMEPS-Household Component
    Immigration StatusBinaryForeign born statusMEPS-Household Component
    Census RegionCategoricalMEPS-Household Component
    Health InsuranceCategoricalHealth insurance coverage and types during the study periodMEPS-Household Component
    Patient characteristics: CommunicationPerceived English ProficiencyBinaryHow well respondents could speak English or how do they feel when conversing in EnglishMEPS-Household Component
    Hearing ProblemBinaryIndication of whether a respondent had serious difficulty hearingMEPS-Household Component
    Patient characteristics: Clinical/health-related characteristicsGeneral Health StatusCategoricalPerceived health statusMEPS-Household Component
    Current SmokingBinarySelf-reported current smoking statusMEPS-Household Component
    ObesityBinarySelf-reported body mass index > 29.9 kg/m2MEPS-Household Component
    HypertensionBinaryIndication of a respondent received a diagnosis or was ever told that having high blood pressure by healthcare providerMEPS-Household Component
    HyperlipidemiaBinaryIndication of a respondent received a diagnosis or was ever told that having high cholesterol by healthcare providerMEPS-Household Component
    AsthmaBinaryIndication of a respondent received a diagnosis or was ever told that having high cholesterol by healthcare providerMEPS-Household Component
    Chronic obstructive pulmonary diseaseBinaryIndication of a respondent received a diagnosis or was ever told that having COPD by healthcare providerMEPS-Household Component
    Diabetes Care: Lifestyle modificationBinaryRespondents were asked whether they were being treated with dietMEPS-Diabetes Care Survey
    Diabetes Care: Oral medicationBinaryRespondents were asked whether they were being treated with oral medicationsMEPS-Diabetes Care Survey
    Diabetes Care: Insulin injectionsBinaryRespondents were asked whether they were being treated with insulinMEPS-Diabetes Care Survey
    Diabetic ComplicationsCVDsBinarySelf-reported diagnosis of any CVD or identified conditions using ICD-9 or 10 codesMEPS-Household Component & Medical Conditions Files
    Kidney problemBinarySelf-reported kidney problem associated with diabetes or identified conditions using ICD-9 or 10 codesMEPS-Diabetes Care Survey & Medical Conditions Files
    Eye problemBinarySelf-reported eye problem associated with diabetes or identified conditions using ICD-9 or 10 codesMEPS-Diabetes Care Survey & Medical Conditions Files
    HospitalizationAll-causeBinaryAny self-reported hospitalization history or identified hospital admission recordsMEPS-Household Component & Hospital Inpatient Stays Files
    Diabetes-specificBinaryIdentified hospital records linked to diabetes using ICD-9 or 10 codesMEPS-Medical Conditions & Hospital Inpatient Stays Files
    Complication-relatedBinaryIdentified hospital records linked to diabetic complications using ICD-9 or 10 codesMEPS-Medical Conditions & Hospital Inpatient Stays Files
    • ICD, International Classification of Diseases; MEPS, Longitudinal Medical Expenditure Panel Survey.

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The Journal of the American Board of Family     Medicine: 33 (6)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 6
November-December 2020
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Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study
Young-Rock Hong, Jinhai Huo, Ara Jo, Michelle Cardel, Arch G. Mainous
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 903-912; DOI: 10.3122/jabfm.2020.06.200217

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Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study
Young-Rock Hong, Jinhai Huo, Ara Jo, Michelle Cardel, Arch G. Mainous
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 903-912; DOI: 10.3122/jabfm.2020.06.200217
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Keywords

  • Diabetes Complications
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