Diabetes Care Quality: Do Large Medical Groups Perform Better?

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To compare primary care management processes (CMPs) and outcome measures for diabetes quality among large, medium, and small medical groups.

STUDY DESIGN: Observational comparison of differences in processes and outcomes over time among 329 primary care practices that agreed to participate and returned completed surveys in both 2017 and 2019.

METHODS: We used a standardized composite measure of diabetes quality along with its 5 components and a survey measure of the presence of systematic CMPs to compare the outcomes and processes of care among clinics that were in large (≥ 12 sites), medium (4-11 sites), and small (1-3 sites) medical groups.

RESULTS: Practices from large groups had better performance than those in medium and small groups on the composite measure of diabetes outcomes in 2017 (46.5 vs 40.6 and 34.4, respectively; P < .001), as well as on each of the 5 component measures. They also had more CMPs in place (74.2% vs 66.9% and 61.4%; P < .001), including the 10 CMPs that are associated with the highest level of performance (84.2% vs 77.9% and 72.2%; P < .001). However, repeated measures in 2019 showed that the smaller groups had gained on both quality and CMP measures. There was also substantial overlap on both CMPs and performance among practices in groups of different sizes.

CONCLUSIONS: On average, primary care practices that are part of large well-established medical groups outperformed smaller-sized groups in diabetes care quality, probably because they have the resources, leadership, and infrastructure to provide more consistent care through more organized CMPs.

Original languageEnglish (US)
Pages (from-to)101-107
Number of pages7
JournalAmerican Journal of Managed Care
Issue number3
StatePublished - Mar 2022

Bibliographical note

Funding Information:
Source of Funding: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award No. R18DK110732. The content is solely the responsibility of the authors and does not necessarily represent the o cial views of the NIH.

Publisher Copyright:
© 2022 Ascend Media. All rights reserved.


  • Diabetes Mellitus/therapy
  • Humans
  • Outcome Assessment, Health Care
  • Quality of Health Care
  • Surveys and Questionnaires

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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