Risk and protective factors associated with screening for complications ofdiabetes in a health maintenance organization setting

OBJECTIVE - To identify risk and protective factors associated with screeni ng for complications of diabetes, we performed a cross-sectional study of 3 ,612 diabetic members enrolled in California Care, a large network-model he alth maintenance organization (HMO). RESEARCH DESIGN AND METHODS - We used the Hearth Plan and Employer Data Inf ormation Set (HEDIS) 3.0 technical definition to identify all members (aged greater than or equal to 31 years) receiving any diabetes medication(s) du ring a 12-month period. Using a telephone survey instrument, identified mem bers were interviewed about their diabetes care and screening, patient, and provider history. Survey data were supplemented with HMO claims and demogr aphic information. Multivariate analysis was performed to identify demograp hic, clinical, and utilization characteristics that affect the odds of diab etic members receiving annual retinal examination, foot examination, and Hb A(1c) testing. RESULTS - While results varied by screening category, the adds of obtaining screening were higher for diabetic members who were older, spoke English, received diabetes nutrition counseling, visited a diabetes specialist physi cian, belonged to a diabetes association or support group, used insulin, pe rformed glycemic level self-examination at least once a day and had higher overall prescription drug use (suggesting higher comorbidity). Since this s tudy is a cross-sectional review these results do not imply a cause-and-eff ect relationship between dependent and independent variables. CONCLUSIONS - Results of this study suggest barriers, risks, and protective factors associated with screening for complications of diabetes. Diabetic members who do not possess these characteristics may be at increased risk.