Visit Frequency for Patients with Type-2 Diabetes Varies More by Organization than by Glucose Control: a Retrospective Cohort Study

  • M. Brooke HerndonEmail author
  • Barbara Gladders
  • Gavin Welch
  • Sanjeev Mehta
  • Thomas Belnap
  • Nancy E. Morden
Concise Research Report


A growing literature raises concerns about the frequency and timing of ambulatory visits among patients with chronic conditions.1, 2, 3, 4, 5 However, to date, few studies have investigated the distribution of ambulatory visits for chronic conditions, especially outside of the Medicare-insured population.

We conducted a retrospective cohort study of 103,220 adults with type-2 diabetes receiving care at nine healthcare organizations within the High Value Healthcare Collaborative (HVHC) between October 2012 and September 2014.6 We measured the association between diabetes control and ambulatory visit frequency.


HVHC organizations submit patient-level clinical and administrative data biannually, including demographics, medical conditions (ICD-9-CM codes), vital signs, laboratory results, ambulatory encounters, hospital admissions, and clinician credentials. We studied data from the 9 of 14 HVHC organizations that had complete data: Baylor Health Care System, Denver...


chronic care organization and delivery of care primary care managed care—quality 



Dr. Herndon, Ms. Gladders, Dr. Welch, and Mr. Belnap received support for this work during 2012–2016 from the Centers for Medicare & Medicaid Services through a Health Care Innovation Grant awarded to the Trustees of Dartmouth College, High Value Healthcare Collaborative: Engaging Patients to Meet the Triple Aim Health Care Innovation Award (awardee number 1C1CMS331029PE). Dr. S. Mehta was supported by National Institutes of Health grant P30DK036836.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Petitti, D.B. and K. Grumbach, Variation in physicians' recommendations about revisit interval for three common conditions. Journal of Family Practice, 1993. 37(3): p. 235-40.PubMedGoogle Scholar
  2. 2.
    DeSalvo, K.B., et al., Predictors of variation in office visit interval assignment. International Journal for Quality in Health Care, 2003. 15(5): p. 399-405.CrossRefGoogle Scholar
  3. 3.
    Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. New England Journal of Medicine, 2007. 356(11): p. 1130-1139.CrossRefGoogle Scholar
  4. 4.
    Yasaitis, L.C., J.P. Bynum, and J.S. Skinner, Association between physician supply, local practice norms, and outpatient visit rates. Medical Care, 2013. 51(6): p. 524-31.CrossRefGoogle Scholar
  5. 5.
    Ganguli, I., J.H. Wasfy, and T.G. Ferris, What is the right number of clinic appointments?: Visit frequency and the accountable care organization. JAMA, 2015. 313(19): p. 1905-6.CrossRefGoogle Scholar
  6. 6.

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • M. Brooke Herndon
    • 1
    Email author
  • Barbara Gladders
    • 2
  • Gavin Welch
    • 3
  • Sanjeev Mehta
    • 4
  • Thomas Belnap
    • 5
  • Nancy E. Morden
    • 6
  1. 1.Section of General Internal MedicineDartmouth Hitchcock Medical Center and the Geisel School of MedicineLebanonUSA
  2. 2.Heart & Vascular Center at Dartmouth Hitchcock Medical CenterLebanonUSA
  3. 3.Quality and Safety Department, Maine Medical CenterPortlandUSA
  4. 4.Joslin Diabetes CenterBostonUSA
  5. 5.Intermountain HealthcareSalt Lake CityUSA
  6. 6.The Dartmouth Institute for Health Policy & Clinical PracticeLebanonUSA

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