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Home Research Research Library The Impact of Social and Clinical Complexity on Diabetes Control Measures The Impact of Social and Clinical Complexity on Diabetes Control Measures 2020 Author(s) Cottrell, Erika K, O’Malley, Jean P, Dambrun, Katie, Park, Brian, Hendricks, Michelle A, Xu, Hongzhi, Charlson, Mary, Bazemore, Andrew W, Shenkman, Elizabeth Ann, Sears, Abby, and DeVoe, Jennifer E Topic(s) Role of Primary Care, and Achieving Health System Goals Keyword(s) Cost Of Care, Payment, Population Health, and Quality Of Care Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine Purpose: In an age of value-based payment, primary care providers are increasingly scrutinized on performance metrics that assess quality of care, including the outcomes of their patient population in key areas such as diabetes control. Although such measures often adjust for patient clinical risk factors or clinical complexity, most do not account for the social complexity of patient populations, despite research demonstrating the strong association between social factors and health. Methods: Using patient electronic health record data from 2 large community health center networks serving safety net patients, we assessed the effect of both clinical and social risk factors on poor glucose control among diabetics. Logistic regression results were used to estimate the impact of adjusting for both clinical and social complexity on provider performance metrics. Clinical complexity was measured at the patient-level using the Charlson Comorbidity Index. Social complexity was measured at the community-level using the Social Deprivation Index. Results: Clinical complexity alone was not consistently associated with poor diabetes control (ie, HbA1c > 9%) in diabetic patients with HbA1c testing during the study period. However, increasing social complexity was significantly associated with higher rates of poor diabetic control in both cohorts. After adding adjustment for social complexity down to the national median score, our models suggest that approximately 25% of providers would have 1 to 2% improvement in the assessment of their diabetes control measures, with 45% showing a 2 to 5% improvement, and 5% showing more than a 5% improvement. Conclusions: Providers caring for patients with greater social risk factors may benefit from having their performance metrics adjusted for the social complexity of their patient populations. ABFM Research Read all 2025 Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model Go to Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model 2016 Access to Primary Care in US Counties Is Associated with Lower Obesity Rates Go to Access to Primary Care in US Counties Is Associated with Lower Obesity Rates 2019 Associations Between Burnout and Practice Organization in Family Physicians Go to Associations Between Burnout and Practice Organization in Family Physicians 2024 Measuring Primary Healthcare Spending Go to Measuring Primary Healthcare Spending
Author(s) Cottrell, Erika K, O’Malley, Jean P, Dambrun, Katie, Park, Brian, Hendricks, Michelle A, Xu, Hongzhi, Charlson, Mary, Bazemore, Andrew W, Shenkman, Elizabeth Ann, Sears, Abby, and DeVoe, Jennifer E Topic(s) Role of Primary Care, and Achieving Health System Goals Keyword(s) Cost Of Care, Payment, Population Health, and Quality Of Care Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine
ABFM Research Read all 2025 Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model Go to Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model 2016 Access to Primary Care in US Counties Is Associated with Lower Obesity Rates Go to Access to Primary Care in US Counties Is Associated with Lower Obesity Rates 2019 Associations Between Burnout and Practice Organization in Family Physicians Go to Associations Between Burnout and Practice Organization in Family Physicians 2024 Measuring Primary Healthcare Spending Go to Measuring Primary Healthcare Spending
2025 Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model Go to Evaluating primary care expenditure in Australia: the Primary Care Spend (PC Spend) model
2016 Access to Primary Care in US Counties Is Associated with Lower Obesity Rates Go to Access to Primary Care in US Counties Is Associated with Lower Obesity Rates
2019 Associations Between Burnout and Practice Organization in Family Physicians Go to Associations Between Burnout and Practice Organization in Family Physicians