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Disparities in Diabetes Care: Differences Between Rural and Urban Patients Within a Large Health System.

Randy Foss1, Karen Fischer2, Michelle A Lampman3

  • 1Department of Family Medicine, Mayo Clinic Health System, Lake City, Minnesota foss.randy@mayo.edu.

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Summary

Rural patients with diabetes receive lower quality care than urban patients, indicated by poorer attainment of the D5 metric. Lower visit frequency and less specialty care in rural areas may contribute to these disparities.

Keywords:
diabetes controlhealth care deliveryhealth care disparitieshealth metricshealth serviceshealth services accessibilitypopulation healthprimary carequality of carerural healthrural health disparitiesvulnerable populations

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Area of Science:

  • Health Services Research
  • Diabetes Care Quality
  • Rural Health Disparities

Background:

  • Quality of diabetes care can vary significantly between rural and urban populations.
  • Understanding these disparities is crucial for improving health outcomes in all patient groups.

Purpose of the Study:

  • To compare the quality of diabetes care between rural and urban patients within a large healthcare system.
  • To identify factors associated with diabetes care quality in different geographic settings.

Main Methods:

  • Retrospective cohort study of 45,279 patients with diabetes.
  • Assessed attainment of the D5 metric (5 key diabetes care components).
  • Analyzed covariates including demographics, complexity scores, insurance, clinician type, and healthcare utilization.

Main Results:

  • Rural patients (54.4% of cohort) were less likely to meet the D5 metric (39.9% vs 43.2%, P <.001).
  • Rural patients had fewer outpatient visits and less frequent endocrinology consultations.
  • Increased outpatient visits correlated with higher D5 metric attainment, while endocrinology visits correlated with lower attainment.

Conclusions:

  • Rural patients experienced worse diabetes quality outcomes compared to urban patients.
  • Lower healthcare utilization and reduced specialty care access in rural areas may explain these differences.
  • Integrated health systems must address geographic disparities to ensure equitable diabetes care quality.