Profiling quality of diabetes care in a veterans affairs healthcare system

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Profiling care on the basis of standard sets of measures has been extensively studied in the inpatient setting. However, less attention has been given to profiling outpatient care. The purpose of this study was to determine the influence of case-mix adjustment when profiling care for persons with diabetes. This is a cross-sectional study using medical and pharmacy data. Four process and 3 outcomes measures were used to assess the quality of care provided between 4 outpatient clinics. Diabetics were predominantly elderly (mean = 66 years), married (61%), white (73%), males (96%), with high body mass index (31 ± 6.3 kg/m2), and mean comorbidity score of 4.2 ± 1.8 conditions. Screening for hemoglobin A1c (HbA1c) and microalbuminuria was frequently performed in all clinics. However, 61% (n = 1697) and 36% (n = 254) of study patients had not undergone foot or eye examinations during the study period, respectively. Approximately 27% (n = 408), 41% (n = 643), and 26% (n = 515) of the study patients had poor glycemic, renal function, and lipid control, respectively. Significant differences (P < .05) in poor HbA1c and creatinine clearance rates between the clinics were observed after adjusting for patient case-mix. No differences between the clinics in cholesterol levels were observed after adjusting for patient case-mix. Overall, these clinics performed well in process of care measures, except for foot screening. After adjusting for patient case-mix, significant disparities between the clinics were observed with respect to glycemic control and renal function measures, whereas differences were nullified with respect to cardiovascular outcome measure.

Original languageEnglish (US)
Pages (from-to)112-120
Number of pages9
JournalAmerican Journal of Medical Quality
Volume19
Issue number3
StatePublished - May 2004

Fingerprint

Quality of Health Care
Veterans
Diagnosis-Related Groups
Delivery of Health Care
Foot
Hemoglobins
Outcome Assessment (Health Care)
Kidney
Risk Adjustment
Process Assessment (Health Care)
Ambulatory Care
Ambulatory Care Facilities
Comorbidity
Inpatients
Creatinine
Body Mass Index
Cross-Sectional Studies
Cholesterol
Lipids

Keywords

  • Case-mix
  • Diabetes
  • Performance measurement
  • Quality of care

ASJC Scopus subject areas

  • Health Policy
  • Nursing(all)

Cite this

Profiling quality of diabetes care in a veterans affairs healthcare system. / Joish, Vijay N.; Malone, Daniel C; Wendel, Christopher S; Mohler, Martha J.

In: American Journal of Medical Quality, Vol. 19, No. 3, 05.2004, p. 112-120.

Research output: Contribution to journalArticle

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