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Problems in Assessing Diabetes Control in an Ambulatory Setting

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Arlene Ash, Ph.D.

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Robert Friedman, M.D.

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Elaine Hickey, R.N.

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Boris Kader, Ph.D.

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Mark A. Moskowitz, M.D.

The HSR&D Field Program, Bedford Veterans Affairs Hospital, Bedford, Massachusetts, and the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts

Problems in using medical records to assess outcomes of diabetes care have not been well defined. We reviewed the medical records of 288 patients with diabetes receiving ambulatory care over a 2-year period. We determined the availability of different tests of glycemic control and described site performance as the percent age of patients with a blood glucose exceeding either 180 or 240 mg/dl. Glycosylated hemoglobin determinations were performed in only 26.7% of patients. A blood glucose was available in 208 patients (72.2%) during a 6-month outcome period. For almost 50% of the sample, the glucose was greater than 180 mg/dl, whereas in 20% it exceeded 240 mg/dl. Judgments of whether sites dif fered in performance depended on how control was defined. Using a single glucose determination and a threshold of 180 mg/dl, similar fractions of patients were poorly controlled at each site (51.2 versus 45.0 versus 47.0%) (P = 0.75). At 240 mg/dl, although, one site per formed much worse than the other two (14.6 versus 16.7 versus 31.8%) ( P = 0.02). These results highlight diffi culties in defining the outcome measure when using med ical records to evaluate quality of care.

American Journal of Medical Quality, Vol. 13, No. 2, 89-93 (1998)
DOI: 10.1177/106286069801300207


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