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Provider deferred decisions on hemoglobin A1c results: a report from the Colorado Research Network (CaReNet) and the
Bennett Parnes1, Linda Niebauer, Sherry Holcomb
1Department of Family Medicine, University of Colorado School of Medicine, Health Sciences Center, 12474 E. 19th Avenue, PO Box 6508, Campus Box F496, Aurora, CO 80045-0508, USA. bennett.parnes@uchsc.edu
Insights
Deferred decisions on elevated Hemoglobin A1c (HbA1c) results are uncommon in type 2 diabetes care. When decisions are deferred, they are typically addressed later, though a small percentage may not be resolved.
Area of Science:
- Clinical Medicine
- Endocrinology
- Primary Care
Background:
- Hemoglobin A1c (HbA1c) results often require complex clinical decisions.
- Decisions regarding elevated HbA1c levels are frequently deferred to future encounters.
- Urgency is rarely a factor in managing elevated HbA1c results.
Purpose of the Study:
- To determine the occurrence rate of deferred clinical decisions for elevated HbA1c.
- To identify predictors associated with deferred HbA1c decisions.
- To ascertain the eventual outcomes of deferred HbA1c decisions.
Main Methods:
- Provider questionnaires were used to capture initial HbA1c review data.
- Chart reviews were conducted six months later for deferred cases.
- The study included providers from 19 primary care clinics in Colorado.
Main Results:
- 10.0% of elevated HbA1c results (HbA1c ≥ 7%) had deferred decisions.
- Deferred decisions were more likely in African American patients (OR 4.91) and less likely when the patient's usual provider reviewed the result (OR 0.40).
- Of deferred cases, 14 out of 18 (77.8%) eventually had a clinical decision made, typically at the next encounter; 4 cases were never addressed.
Conclusions:
- Deferred decisions on Hemoglobin A1c results are infrequent in primary care settings.
- Most deferred HbA1c decisions are eventually addressed in subsequent clinical encounters.
- Predictors for deferral include patient race and provider familiarity.
Background:
Hemoglobin A1c (HbA1c) results are generally reviewed several days after office visits. The clinical decisions on elevated HbA1cs may be complex and are rarely urgent. Providers may elect to defer the decision or its implementation to a future clinical encounter.
Objective:
To determine the occurrence rate, predictors, and eventual decision outcomes for HbA1c deferred decisions.
Design:
Provider questionnaire completed when HbA1c results from type 2 diabetes patients were reviewed, followed by a chart review on deferred cases 6 months later.
Participants:
Providers at 19 Colorado primary care clinics.
Measurements:
For HbA1c > or =7%, whether the decision or its implementation was deferred. In deferred cases, whether a clinical decision was eventually made.
Results:
Of the 311 HbA1cs > or =7%, 31 (10.0%) had deferred decisions. In multivariate analysis, deferred decisions were more likely in African Americans (odds ratio [OR] 4.91, 95% CI 1.81, 13.3) and less likely when the patient's usual provider reviewed the HbA1c (OR 0.40, 95% CI 0.18, 0.90). In the chart review, for deferred cases (n = 18), a clinical decision was made in 14 cases, usually at the next clinical encounter. In 4 cases, the HbA1c was never addressed.
Conclusion:
Deferred decisions on HbA1c results are infrequent, and usually the HbA1c is eventually addressed.