Provider Deferred Decisions on Hemoglobin A1c Results: A Report from the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN)

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Abstract
Background: Hemoglobin A1c (HbA1c) results are generally reviewed several days after office visits. The clinical decisions on elevated HbA1cs may be complex and are rarely urgent. Providers may elect to defer the decision or its implementation to a future clinical encounter. Objective: To determine the occurrence rate, predictors, and eventual decision outcomes for HbA1c deferred decisions. Design: Provider questionnaire completed when HbA1c results from type 2 diabetes patients were reviewed, followed by a chart review on deferred cases 6 months later. Participants: Providers at 19 Colorado primary care clinics. Measurements: For HbA1c ≥7%, whether the decision or its implementation was deferred. In deferred cases, whether a clinical decision was eventually made. Results: Of the 311 HbA1cs ≥7%, 31 (10.0%) had deferred decisions. In multivariate analysis, deferred decisions were more likely in African Americans (odds ratio [OR] 4.91, 95% CI 1.81, 13.3) and less likely when the patient’s usual provider reviewed the HbA1c (OR 0.40, 95% CI 0.18, 0.90). In the chart review, for deferred cases (n = 18), a clinical decision was made in 14 cases, usually at the next clinical encounter. In 4 cases, the HbA1c was never addressed. Conclusion: Deferred decisions on HbA1c results are infrequent, and usually the HbA1c is eventually addressed.