Use of Medicare's Diabetes Self-Management Training Benefit
Use of Medicare's Diabetes Self-Management Training Benefit
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DOI：
10.1177/1090198114566271
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发表时间：
2015-08-01
影响因子：
4.2
通讯作者：
Howell, Benjamin L.
中科院分区：
文献类型：
--
作者：
Strawbridge, Larisa M.;Lloyd, Jennifer T.;Howell, Benjamin L.
医疗保险在2000年开始报销门诊糖尿病自我管理培训（DSMT）;然而，对该计划的利用率知之甚少。在2010年被诊断患有糖尿病的人是从20%的医疗保险付费服务人群（N = 110，064）中随机选择的。医疗保险管理和索赔文件被用来确定DSMT利用率。多变量logistic回归分析评估了人口统计学、健康状况和提供者可用性因素与DSMT利用率的相关性。大约5%的新诊断糖尿病的医疗保险受益人使用DSMT服务。调整后的任何利用率在男性中低于女性，老年人与年轻人相比，非白人与白人相比，双重符合医疗保险和医疗补助条件的人与非双重死亡相比，患有合并症的患者与没有这些条件的人相比。此外，随着提供DSMT服务的供应商的增加和人口普查地区的不同，利用DSMT的调整几率也增加了。新诊断糖尿病的医疗保险受益人中DSMT的使用率很低。人口统计学和健康状况因素以及DSMT提供者的可用性似乎在获得DSMT方面存在明显差异。鉴于糖尿病患病率的增加，未来的研究应确定DSMT访问的障碍，描述DSMT提供者，并探讨DSMT服务的影响。随着保险公司越来越多地提供预防性服务，已经存在了近15年的预防性服务福利-DSMT-的利用率很低，突出表明了在广泛传播和采用新服务方面可能遇到的挑战。
Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization. Multivariate logistic regression analyses evaluated the association of demographic, health status, and provider availability factors with DSMT utilization. Approximately 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services. The adjusted odds of any utilization were lower among men compared with women, older individuals compared with younger, non-Whites compared with Whites, people dually eligible for Medicare and Medicaid compared with nondual eligibles, and patients with comorbidities compared with individuals without those conditions. Additionally, the adjusted odds of utilizing DSMT increased as the availability of providers who offered DSMT services increased and varied by Census region. Utilization of DSMT among Medicare beneficiaries with newly diagnosed diabetes is low. There appear to be marked disparities in access to DSMT by demographic and health status factors and availability of DSMT providers. In light of the increasing prevalence of diabetes, future research should identify barriers to DSMT access, describe DSMT providers, and explore the impact of DSMT services. With preventive services being increasingly covered by insurers, the low utilization of DSMT, a preventive service benefit that has existed for almost 15 years, highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services.