Diabetes self-management education and training (DSMT) is an important part of clinical management of diabetes that helps persons with diabetes stay healthy. The American Diabetes Association recommends persons with diabetes receive DSMT at diagnosis and as needed thereafter. Diabetes education is associated with increased use of primary and preventive services and lower use of acute, inpatient hospital services. DSMT has also been associated with increased glycemic stability among diabetic patients. Furthermore, nutrition-based interventions have proven to be both effective at producing physical indicators of increased metabolic health, an important aspect of diabetes management, and cost-effective in terms of savings generated by their usage.

However, previous studies have shown that utilization of DSMT services is altered by geographic region and availability of such services, despite coverage by Medicare Part B. Using the publicly available Medicare Provider Utilization and Payment Data supplemented by unique clinic site and physician-level information for 30,000 family physicians nationally that is only available through the American Board of Family Medicine, we propose to investigate geographic disparities (i.e., rural versus urban) in the provision of DSMT, Medical Nutrition Therapy (MNT), and Health and Behavior Assessment and Intervention (HBAI) and identify whether challenges or barriers exist for rural providers in billing for these services, as well as propose solutions to addressing challenges faced by providers in billing for these services in disparate populations. Using national county-level aggregate totals of DSMT, MNT, and HBAI services among Medicare fee-for-service beneficiaries from 2012 to 2015, we will compare rural and urban providers to determine characteristics of the practice sites on a national level.

It is expected that this research will generate at least one policy brief or manuscript and one abstract for presentation at a national level.

Publications

• Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 06/2020
  Identifying behaviors that contribute to disease and modifying them can be an important step in treatment. This study investigated geographic disparities and the availability of Health and Behavioral Assessments and Interventions services in rural and urban areas by examining fee-for-service Medicare beneficiaries in 2012-2016.
• Rural/Urban Disparities in Utilization of Diabetes Self-Management Training to the Fee-for-Service Medicare Population
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 06/2020
  Diabetes self-management training (DSMT) is recommended for all newly diagnosed patients with diabetes. However, the utilization rate of DSMT is low, and geographic disparities in availability exist. This study sought to identify the extent of the rural/urban disparity in the provision of DSMT to fee-for-service Medicare beneficiaries in 2012-2016.
• Rural/Urban Disparities in Utilization of Medical Nutrition Therapy to the Fee-for-Service Medicare Population
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 06/2020
  Medical Nutrition Therapy (MNT) is important in the treatment of many chronic conditions, but the availability of MNT in rural versus urban communities has not been examined. This study sought to identify the availability of MNT in rural and urban communities by examining Medicare fee-for-service beneficiaries in 2012-2016.