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American Journal of Medical Quality, Vol. 19, No. 1, 12-18 (2004)
DOI: 10.1177/106286060401900103

Variations in Diabetes Care and the Influence of Office Systems

Edward F. Ellerbeck, MD, MPH

Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, Kan and The Kansas Foundation for Medical Care, Inc, Topeka, Kan and Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, Kan, eellerbe{at}kumc.edu

Kimberly K. Engelman, PhD

Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, Kan and The Kansas Foundation for Medical Care, Inc, Topeka, Kan

N. Jeannie Williams, MD

Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, Kan

Niaman Nazir, MBBS

Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, Kan

Samuel J. Markello, PhD

The Kansas Foundation for Medical Care, Inc, Topeka, Kan

Although a variety of office tools have been shown to improve diabetes care, the use and effectiveness of these tools outside the context of clinical trials is largely unknown. We surveyed primary care practices in Kansas. Using Medicare claims, we identified patients with diabetes, linked them to practices, and assessed the use of glycohemoglobin (GHb) tests, eye examinations, and lipid profiles. Performance rates among practices ranged from 15% to 100% (mean = 84%) for GHb tests, 20% to 100% (mean = 70%) for lipid profiles, and 50% to 100% (mean = 78%) for eye examinations. None of the practices used computerized tracking systems, 29% used diabetes flowsheets, and 33% allocated specific diabetes care responsibilities to nonphysician personnel. Neither use of flowsheets nor use of nonphysician personnel was associated with improvements in diabetes care. Although practices varied widely in their care of patients with diabetes, as currently implemented, office system tools have not led to consistently better performance.


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