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Quality of Care of Medicare Patients With Diabetes in a Metropolitan Fee-for-Service Primary Care Integrated Delivery System

Baylor-Ruth Collins Diabetes Center at Baylor University Medical Center, Dallas, Texas

David Nicewander, MS

Institute for Health Care Research and Improvement, Dallas, Texas

Carl Couch, MD, MMM

HealthTexas Provider Network, Dallas, Texas

David Winter, MD, MSc

HealthTexas Provider Network, Dallas, Texas

Jeph Herrin, PhD

Flying Buttress Associates, Charlottesville, Virginia

Ziad Haydar, MD

Baylor Senior Health Network and Baylor Senior Health Center, Dallas, Texas

David J. Ballard, MD, MSPH, PhD

Institute for Health Care Research and Improvement, Dallas, Texas, dj.ballard{at}baylorhealth.edu

Diabetes care in the United States is suboptimal. Although closed-panel health maintenance organizations (HMOs) and the Department of Veterans Affairs (VA) report performance superior to national norms, fee-for-service performance is uncertain. To address this issue, 3 outcome and 5 process indicators were measured for 2010 Medicare diabetes patients across 22 sites in a large, fee-for-service primary care group practice. American Diabetes Association standards for glycemic control, low-density lipoprotein cholesterol, and blood pressure were met by 53%, 46%, and 19% of patients, respectively. Diabetes Quality Improvement Project/Alliance poor control markers for the same measures were exceeded by 9%, 20%, and 54% of patients. Chart abstraction demonstrated annual eye examination, foot examination, and nephropathy screening rates of 16%, 49%, and 38%, while Medicare claims showed an annual eye examination rate of 63%. Observed processes and outcomes in this fee-for-service setting were superior to reported national performance and similar to the best performance in staff-model HMOs and the VA.

Key Words: diabetes mellitus • quality of care • primary care • fee for service

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