Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;53(2):1042-1064.
doi: 10.1111/1475-6773.12675. Epub 2017 Mar 10.

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care

Marina Soley-Bori  1   2   3 , Justin K Benzer  2   4   5 , James F Burgess Jr  1   2
Affiliations

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care

Marina Soley-Bori et al. Health Serv Res. 2018 Apr.

Abstract

Objective: To assess the influence of relational climate on quality of diabetes care.

Data sources/study setting: The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets.

Study design: Multilevel panel data (2008-2012) with patients nested into clinics.

Data collection/extraction methods: Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure).

Principal findings: The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes.

Conclusions: Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care.

Keywords: Diabetes; primary care; quality of care; relational climate.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Agency for Healthcare Research and Quality . 2011. “Healthcare Cost and Utilization Project (Comorbidity Software, Version 3.7)” [accessed on April 15, 2015]. Available at http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp
    1. Allocation Resource Center . 2013. Patient Classification Handbook. Braintree, MA: Department of Veterans Affairs.
    1. Arthur, J. B. , and Boyles T.. 2007. “Validating the Human Resource System Structure: A Levels‐Based Strategic HRM Approach.” Human Resource Management Review 17 (1): 77–92.
    1. Ayanian, J. Z. , and Weissman J. S.. 2002. “Teaching Hospitals and Quality of Care: A Review of the Literature.” The Milbank Quarterly 80 (3): 569–93, v. - PMC - PubMed
    1. Ayanian, J. Z. , Weissman J. S., Chasan‐Taber S., and Epstein A. M.. 1998. “Quality of Care for Two Common Illnesses in Teaching and Nonteaching Hospitals.” Health Affairs (Project Hope) 17 (6): 194–205. - PubMed

MeSH terms

LinkOut - more resources