{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:48:22Z","timestamp":1754164102208,"version":"3.41.2"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Swiss National Science Foundation (SNSF) National Research Program \"Smarter Health Care\"","award":["407440_167349"],"award-info":[{"award-number":["407440_167349"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2020,1,22]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Four strongly recommended diabetes management measures are biannual glycated hemoglobin (HbA1c) testing, annual eye examination, kidney function examination, and low-density lipoprotein (LDL) testing in patients below 75 years. We aimed to describe regional variation in the utilization of the four measures across small regions in Switzerland and to explore potential influencing factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We conducted a cross-sectional study of adult patients with drug-treated diabetes in 2014 using claims data. Four binary outcomes represented adherence to the recommendations. Possible influencing factors included sociodemographics, health insurance preferences, and clinical characteristics. We performed multilevel modeling with Medstat regions as the higher level. We calculated the median odds ratio (MOR) and checked spatial autocorrelation in region level residuals using Moran\u2019s I statistic. When significant, we further conducted spatial multilevel modeling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 49\u2009198 patients with diabetes (33\u2009957 below 75 years), 69.6% had biannual HbA1c testing, 44.3% each had annual eye examination and kidney function examination, and 55.5% of the patients below 75 years had annual LDL testing. The effects of health insurance preferences were substantial and consistent. Having any supplementary insurance (ORs across measures were between 1.08 and 1.28), having supplementary hospital care insurance (1.08\u20131.30), having chosen a lower deductible level (eg, SFr2500 compared with SFr300: 0.57\u20130.69), and having chosen a managed care model (1.04\u20131.17) were positively associated with recommendations adherence. The MORs (1.27\u20131.33) showed only moderate unexplained variation, and we observed inconsistent spatial patterns of unexplained variation across the four measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings indicate that the uptake of strongly recommended measures in diabetes management could possibly be optimized by providing further incentives to patients and care providers through insurance scheme design. The absence of marked regional variation implies limited potential for improvement by targeted regional intervention, while provider-specific promotion may be more impactful.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2019-001059","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T05:06:05Z","timestamp":1582520765000},"page":"e001059","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Exploring geographic variation of and influencing factors for utilization of four diabetes management measures in Swiss population using claims data"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-8416","authenticated-orcid":false,"given":"Wenjia","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Gruebner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"},{"name":"Department of Geography, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"von Wyl","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Dressel","sequence":"additional","affiliation":[{"name":"Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agne","family":"Ulyte","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6173-5375","authenticated-orcid":false,"given":"Beat","family":"Br\u00fcngger","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"},{"name":"Department of Health Sciences, Helsana Versicherungen AG, D\u00fcbendorf, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Blozik","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Helsana Versicherungen AG, D\u00fcbendorf, Switzerland"},{"name":"Division of General Practice, University Medical Center Freiburg, Freiburg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"B\u00e4hler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"},{"name":"Department of Health Sciences, Helsana Versicherungen AG, D\u00fcbendorf, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Braun","sequence":"additional","affiliation":[{"name":"Departments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Schwenkglenks","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,23]]},"reference":[{"key":"2025073113165871000_8.1.e001059.1","unstructured":"WHO . Global report on diabetes, 2016. Available: https:\/\/www.who.int\/diabetes\/global-report\/en\/"},{"key":"2025073113165871000_8.1.e001059.2","unstructured":"Diabetes a \u2018defining issue for global public health\u2019, 2016. Available: https:\/\/www.swissinfo.ch\/eng\/world-health-study_diabetes-a-defining-issue-for-global-public-health\/42070902"},{"key":"2025073113165871000_8.1.e001059.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2013.11.007"},{"key":"2025073113165871000_8.1.e001059.4","unstructured":"Kriterien f\u00fcr \u201egutes\u201c Disease Management Diabetes in der Grundversorgung . Schweizerische Gesellschaft f\u00fcr Endokrinologie und Diabetologie., 2017. Available: https:\/\/www.sgedssed.ch\/diabetologie\/praxis-tools-fuer-die-grundversorgung?key=1-8&amp;cHash=c5691c4b4cce0faa42491499f3f2e5ab"},{"key":"2025073113165871000_8.1.e001059.5","doi-asserted-by":"publisher","DOI":"10.2337\/cd18-0105"},{"key":"2025073113165871000_8.1.e001059.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht108"},{"key":"2025073113165871000_8.1.e001059.7","first-page":"S41","article-title":"Guidelines and performance measures for diabetes","volume":"13","author":"Ahmann","year":"2007","journal-title":"Am J Manag Care"},{"key":"2025073113165871000_8.1.e001059.8","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.2.398"},{"key":"2025073113165871000_8.1.e001059.9","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.10.1815"},{"key":"2025073113165871000_8.1.e001059.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0033839","article-title":"The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes","volume":"7","author":"Giorda","year":"2012","journal-title":"PLoS One"},{"key":"2025073113165871000_8.1.e001059.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2014.01.009"},{"key":"2025073113165871000_8.1.e001059.12","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzr036"},{"key":"2025073113165871000_8.1.e001059.13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2147\/PPA.S99895","article-title":"A set of four simple performance measures reflecting adherence to guidelines predicts hospitalization: a claims-based cohort study of patients with diabetes","volume":"10","author":"Huber","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"2025073113165871000_8.1.e001059.14","unstructured":"Appleby JRV , Frosini F , Bevan G , et al . Variations in health care: the good, the bad and the inexplicable. King\u2019s Fund 2011."},{"key":"2025073113165871000_8.1.e001059.15","unstructured":"Wennberg JE . Tracking medicine. 9. Oxford: Oxford University Press, 2010."},{"key":"2025073113165871000_8.1.e001059.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7370.961"},{"key":"2025073113165871000_8.1.e001059.17","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2147\/TCRM.S109214","article-title":"How does hospitalization affect continuity of drug therapy: an exploratory study","volume":"12","author":"Blozik","year":"2016","journal-title":"Ther Clin Risk Manag"},{"key":"2025073113165871000_8.1.e001059.18","doi-asserted-by":"crossref","DOI":"10.5334\/ijic.685","article-title":"An empirical investigation of the efficiency effects of integrated care models in Switzerland","volume":"12","author":"Reich","year":"2012","journal-title":"Int J Integr Care"},{"key":"2025073113165871000_8.1.e001059.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-027138","article-title":"Measuring diabetes guideline adherence with claims data: systematic construction of indicators and related challenges","volume":"9","author":"Ulyte","year":"2019","journal-title":"BMJ Open"},{"key":"2025073113165871000_8.1.e001059.20","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-1030","article-title":"Identifying patients with chronic conditions using pharmacy data in Switzerland: an updated mapping approach to the classification of medications","volume":"13","author":"Huber","year":"2013","journal-title":"BMC Public Health"},{"key":"2025073113165871000_8.1.e001059.21","unstructured":"Medstat-Regionen . Bundesamt f\u00fcr Statistik, 2008. Available: https:\/\/www.bfs.admin.ch\/bfs\/de\/home\/statistiken\/gesundheit\/nomenklaturen\/medsreg.html"},{"key":"2025073113165871000_8.1.e001059.22","doi-asserted-by":"crossref","unstructured":"Srinivasan S . Local and global spatial statistics. encyclopedia of GIS. Boston, MA: Springer US, 2008: 615\u201315.","DOI":"10.1007\/978-0-387-35973-1_700"},{"key":"2025073113165871000_8.1.e001059.23","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9868.00353"},{"key":"2025073113165871000_8.1.e001059.24","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi017"},{"key":"2025073113165871000_8.1.e001059.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.2000.00909.x"},{"key":"2025073113165871000_8.1.e001059.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-005-0975-9"},{"key":"2025073113165871000_8.1.e001059.27","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40608-016-0092-6","article-title":"Finding big shots: small-area mapping and spatial modelling of obesity among Swiss male conscripts","volume":"3","author":"Panczak","year":"2016","journal-title":"BMC Obesity"},{"key":"2025073113165871000_8.1.e001059.28","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ehb.2017.01.005","article-title":"A tall order: small area mapping and modelling of adult height among Swiss male conscripts","volume":"26","author":"Panczak","year":"2017","journal-title":"Economics & Human Biology"},{"key":"2025073113165871000_8.1.e001059.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-021006","article-title":"Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey","volume":"8","author":"Riesen","year":"2018","journal-title":"BMJ Open"},{"key":"2025073113165871000_8.1.e001059.30","doi-asserted-by":"publisher","DOI":"10.1007\/s00180-010-0208-2"},{"key":"2025073113165871000_8.1.e001059.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9868.2008.00700.x"},{"key":"2025073113165871000_8.1.e001059.32","unstructured":"R Core Team . R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2018. https:\/\/www.r-project.org\/"},{"key":"2025073113165871000_8.1.e001059.33","unstructured":"Charlton C , Rasbash J , Browne WJ , et al . MLwiN version 3.04 2019."},{"key":"2025073113165871000_8.1.e001059.34","unstructured":"QGIS Development Team . QGIS Geographic Information System. Open Source Geospatial Foundation Project. Available: https:\/\/qgis.org\/en\/site\/ [Accessed 18 Jun 2019]."},{"key":"2025073113165871000_8.1.e001059.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.0016-7363.2005.00671.x"},{"key":"2025073113165871000_8.1.e001059.36","article-title":"A1c testing and its sociodemographic predictors: implications for diabetes self-management programs","volume":"1","author":"Nepal","year":"2014","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"2025073113165871000_8.1.e001059.37","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/intqhc\/mzy186","article-title":"Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations","volume":"31","author":"Corrao","year":"2019","journal-title":"Int J Qual Health Care"},{"key":"2025073113165871000_8.1.e001059.38","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2016-000291","article-title":"Process quality of diabetes care under favorable access to healthcare: a 2-year longitudinal study using claims data in Japan","volume":"4","author":"Tanaka","year":"2016","journal-title":"BMJ Open Diab Res Care"},{"key":"2025073113165871000_8.1.e001059.39","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-0828"},{"key":"2025073113165871000_8.1.e001059.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.0d362.x"},{"key":"2025073113165871000_8.1.e001059.41","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1353\/hpu.2011.0067","article-title":"Better care at safety net providers? Utilization of recommended standards of diabetes care for rural Latinos in one Midwestern state","volume":"22","author":"Sadowski","year":"2011","journal-title":"J Health Care Poor Underserved"},{"key":"2025073113165871000_8.1.e001059.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2004.03.004"},{"key":"2025073113165871000_8.1.e001059.43","first-page":"362","article-title":"Gender differences in healthcare utilization of patients with diabetes","volume":"18","author":"Kr\u00e4mer","year":"2012","journal-title":"Am J Manag Care"},{"key":"2025073113165871000_8.1.e001059.44","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000076542","article-title":"Health care resource utilization and costs of NSAID-induced gastrointestinal toxicity. A population-based study in Switzerland","volume":"69","author":"Delco","year":"2004","journal-title":"Digestion"},{"key":"2025073113165871000_8.1.e001059.45","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/MLR.0000000000000634","article-title":"Regional variation of cost of care in the last 12 months of life in Switzerland: small-area analysis using insurance claims data","volume":"55","author":"Panczak","year":"2017","journal-title":"Medical care"},{"key":"2025073113165871000_8.1.e001059.46","article-title":"Health care renunciation for economic reasons in Switzerland","volume":"141","author":"Wolff","year":"2011","journal-title":"Swiss Med Wkly"},{"key":"2025073113165871000_8.1.e001059.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2012.08.005"},{"key":"2025073113165871000_8.1.e001059.48","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.2147\/PPA.S170134","article-title":"Effect of different methods for estimating persistence and adherence to new glucose-lowering drugs: results of an observational, inception cohort study in Portugal","volume":"12","author":"Torre","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"2025073113165871000_8.1.e001059.49","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2017-000406","article-title":"Primary care physicians\u2019 utilization of type 2 diabetes screening guidelines and referrals to behavioral interventions: a survey-linked retrospective study","volume":"5","author":"Mehta","year":"2017","journal-title":"BMJ Open Diab Res Care"},{"key":"2025073113165871000_8.1.e001059.50","unstructured":"Swiss Diabetes Association . Facts + Figures, 2014. Available: http:\/\/www.diabetesschweiz.ch\/diabetes\/facts-figures\/"}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2019-001059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T20:17:06Z","timestamp":1753993026000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2019-001059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,2,23]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bmjdrc-2019-001059"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2019-001059","relation":{},"ISSN":["2052-4897"],"issn-type":[{"type":"electronic","value":"2052-4897"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}