This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Joish, V. N. Articles by Mohler, M. J. Search for Related Content PubMed PubMed Citation Articles by Joish, V. N. Articles by Mohler, M. J. Social Bookmarking                         What's this?

Profiling Quality of Diabetes Care in a Veterans Mfairs Healthcare System

Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, Utah, vijay.joishipharm.utah.edu

Daniel C. Malone, PhD

Department of Pharmacy Practice and Sciences, College of Pharmacy, The University of Arizona, Tucson, Ariz

Christopher Wendel, MS

Health Services Research Center, Southern Arizona VA Health Care System, Tucson, Ariz

M. Jane Mohler, MPH, PhD

Health Services Research Center, Southern Arizona VA Health Care System, Tucson, Ariz

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 out-patient 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 out-comes measures were used to assess the quality of care provided between 4 outpatient clinics. Diabetics were pre-dominantly 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 Alc (HbAlc) and micro-albuminuria 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 HbAlc 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.

Key Words: Case-mix • diabetes • performance measurement • quality of care

American Journal of Medical Quality, Vol. 19, No. 3, 112-120 (2004)
DOI: 10.1177/106286060401900304


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. L. Maciejewski, C.-F. Liu, and S. D. Fihn Performance of Comorbidity, Risk Adjustment, and Functional Status Measures in Expenditure Prediction for Patients With Diabetes Diabetes Care, January 1, 2009; 32(1): 75 - 80. [Abstract] [Full Text] [PDF]