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Who Treats Patients with Diabetes and Compensated Cirrhosis.

Who Treats Patients with Diabetes and Compensated Cirrhosis.
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Liu TL, Barritt Iv AS, Weinberger M, Paul JE, Fried B, Trogdon JG,


Liu TL, Barritt Iv AS, Weinberger M, Paul JE, Fried B, Trogdon JG, (click to view)

Liu TL, Barritt Iv AS, Weinberger M, Paul JE, Fried B, Trogdon JG,

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PloS one 2016 Oct 2611(10) e0165574 doi 10.1371/journal.pone.0165574
Abstract
BACKGROUND
Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis.

OBJECTIVE
We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis.

DESIGN
Retrospective cross-sectional study using 2000-2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases.

PATIENTS
We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded.

MAIN MEASURES
Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories.

KEY RESULTS
Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%).

CONCLUSIONS
This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination.

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