Search

Context: Type 2 diabetes mellitus continues to grow as a national health priority that disproportionately affects rural patients. Objective: To compare patient level quality outcome data between rural and urban patients across a large integrated health system and assess healthcare utilization differences. Study design and Analysis: Retrospective cross-sectional study Setting or Dataset: Clinical data was collected those with type 2 diabetes across Mayo Clinic Family Medicine Midwest practice. Patient level data included address, age, sex, race, ACG score (marker of complexity), insurance status, primary care clinician, and utilization data. Population studied: Empaneled patients with an ICD-10 diagnosis of type 2 diabetes mellitus (45,279). Intervention/Instrument: Patients were divided into rural and urban cohorts based on RUCA codes then outcomes and utilization were analyzed using logistic regression and linear mixed models, with site and provider as random effects. Outcome measures: Patients meeting 5 criteria included in a composite quality metric for diabetes management (D5) Results: Rural patients were significantly less likely to have met all D5 criteria than urban patients (OR 0.93 (95% CI 0.88-0.97)). Utilization analysis shows that rural patients had fewer outpatient visits than their urban counterparts (mean visits 3.2 v 3.9, p<.0001) and fewer endocrinology visits (5.5% of patients v 9.3%, p<.0001). Medicaid patients were less likely to have met D5 compared to commercially insured patients (OR 0.58 (0.53-0.63)), whereas Medicare patients were more likely to have met D5 outcomes than commercially insured patients (1.17 (1.10-1.24)). Patients with non-white ethnicity were less likely to meet D5 (0.83 (0.77-0.90)), as were those with an endocrine visit during the study period (0.80 (0.73-0.86)). The number of outpatient visits was positively associated with D5 attainment (1.03 (1.03, 1.04)) as was female sex (1.08 (1.04, 1.12)), advancing age (1.02 (1.01, 1.02)) and lower ACG (1.19 (1.14, 1.25)). Provider type (NP/PA vs. physician) was unrelated to D5 outcome (0.94 (0.87, 1.02)). Conclusions: Rural patients had worse diabetic quality outcomes than their urban counterparts, even after adjustment for other contributing factors and despite being part of the same integrated health system. Increasing visit frequency may improve D5 outcomes in rural patients. [ABSTRACT FROM AUTHOR]

Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults. The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 1:1:1 allocation to one of three study groups: (1) Control Condition-no additional study intervention (n = 30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n = 30); (3) Loaner Digital Device + Coaching Support–loaner device plus up to six, 15–20 min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n = 30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience. A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions. Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities. • Digital access to smoking treatment programs is reduced among rural populations. • The IDEA study will evaluate three digital access and literacy interventions. • Findings may have relevance to health systems aiming to foster digital inclusion. [ABSTRACT FROM AUTHOR]