Do You See Anything Wrong with this Comparison?
This is from a Reuters story on the latest Dartmouth Atlas report:
Diabetes patients lose sensation and small injuries that would heal quickly in a healthy person can fester in a diabetic and often feet or legs must be removed because of infection. Good primary care should prevent such an extreme complication…
“However, patients’ risk of leg amputation varied dramatically depending upon who they were and where they lived.” For instance, only 0.3 in 1,000 people had a leg amputated between 2003 and 2007 in Provo, Utah, compared with 3.29 per 1,000 beneficiaries in McAllen, Texas — a tenfold difference.
Here is another dubious comparison:
Wilmington, N.C., has 69 primary-care docs per 100,000 residents. White Plains, N.Y., has 101.4. In which city do you think a Medicare beneficiary was more likely to see a primary care doctor during a year?
According to [the] report…87.4% of Wilmington Medicare recipients had at least one annual primary-care visit during 2003-07, compared to fewer than 70% of White Plains’ beneficiaries. Those stats underlie one of the report’s major conclusions: “There is no simple relationship between the supply of physicians and access to primary care.”
In both cases, the two sets of statistics are derived from different sample populations.
1) amputation rates do not discriminate between diabetic amputations and those due to other causes
2) the first set of data includes all residents, the second is medicare population only.
At least the Dartmouth researchers admitted that access to coverage isn’t the same as access to care. Moreover, some people simply don’t seek out or receive care even when they have coverage or access to a physician.
McAllen Texas, isn’t that the city that Atul Gawande wrote was full of private hospitals that profit share with doctors who send them patients. Where doctors demand annual kickbacks from hospital managers. There’s not much money in getting your diabetes patients to control their eating, but there’s lots of money in amputations.
I agree with BuddhaFrog and would add that a diabetic might be better off seeing an endocrinologist rather than the “primary care provider” preferred by government run health care advocates. A diabetic seeing an endocrinologist could be getting excellent care but this report, thanks to its irrational emphasis on primary care, would be incapable of measuring it.
I would guess that maybe 5% of the residents of Provo have diabetes, compared to maybe half in Mcllen. Of course there are going to be more amputations in McAllen. How could it be otherwise?
artk: yes, it is the same city that Gawande wrote about.
It’s got one of the highest poverty rates in the nation. I would bet that plays a huge role in amputations due to diabates.
McAllen’s demographics are much different than Provo, Utah. I would expect the 10-fold difference in leg amputations could be attributed to ethnicity, genetic predisposition and lifestyle alone.
Well, Virginia, it turns out that Provo, Utah has a higher poverty rate than McAllen Texas. In Provo, 30% of the population earns below the poverty rate and 15% earns less than 50% of the poverty rate. In McAllen, 27% of the population earns less than the poverty rate, and 12% earns less than 50% of the poverty rate.
And Devon, on of the key points of Atul’s article was how McAllen differed from El Paso, a city with identical demographics. In a follow up, Atul said
“McAllen’s medical community and culture simply did more—more surgery, more imaging, more specialist visits, more home-nursing visits—without clear benefit. The lesson was that more is not necessarily better”