This Article Abstract Free Full Text (Free PDF) Free 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 Web of Science 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 Schade, C. P. Articles by Hannah, K. L. Search for Related Content PubMed PubMed Citation Articles by Schade, C. P. Articles by Hannah, K. L. Pubmed/NCBI databases Medline Plus Health Information Diabetes Complications Social Bookmarking                         What's this?

Quality of Ambulatory Care for Diabetes and Lower-Extremity Amputation

West Virginia Medical Institute, Inc

Karen L. Hannah, MBA

West Virginia Medical Institute, Inc, khannah{at}wvmi.org

Lower extremity amputation (LEA) is a serious complication of diabetes. We sought to determine whether quality of ambulatory care affects risk of LEA. We conducted a claims-based case-control study of 409 Medicare beneficiaries younger than age 75 with diabetes and LEA between January 1, 2003, and December 31, 2005. They were matched with controls with diabetes without LEA, on age, gender, number of diabetes outpatient visits, and (for those with hospital admissions between January 1, 2000, and December 31, 2002) number of comorbid conditions, diabetes complications, and peripheral vascular disease. Quality-of-care measures for cases and controls covered the period April 1, 1999, through March 31, 2001. LEA patients were less likely to have had lipid screening than controls (odds ratio = 0.73; 95% confidence interval = 0.53-0.99), and controls were more likely to use physicians with high performance in lipid screening (² = 6.631, P = .012) and hemoglobin A1c testing (² = 6.079, P = .014). (Am J Med Qual 2007;22:410-417)

Key Words: health care quality • diabetes mellitus • Medicare • lower extremity • amputation

References

• Molitch MD, Genuth S. Complications in diabetes. In: Dale DC, ed. ACP Medicine. New York, NY: WebMD Professional Publishing; 2007:1.
• Selby JV, Zhang D. Risk factors for lower extremity amputation in persons with diabetes. Diabetes Care. 1995;18:509-516.[Abstract]
• Lehto S., Ronnemaa T., Pyorala K., Laakso M. Risk factors predicting lower extremity amputations in patients with NIDDM. Diabetes Care. 1996;19:607-612.[Abstract]
• Reiber GE, Pecoraro RE, Koepsell TD Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992;117:97-105.[Abstract/Free Full Text]
• Mayfield JA, Reiber GE, Nelson RG, Greene T. Do foot examinations reduce the risk of diabetic amputation? J Fam Pract. 2000;49:499-504.[Web of Science][Medline] [Order article via Infotrieve]
• Hospital discharge rates for nontraumatic lower extremity amputation by diabetes status—United States, 1997. MMWR Morb Mortal Wkly Rep. 2001;50:954-958.[Medline] [Order article via Infotrieve]
• Wrobel JS, Mayfield JA, Reiber GE Geographic variation of lower-extremity major amputation in individuals with and without diabetes in the Medicare population. Diabetes Care. 2001;24:860-864.[Abstract/Free Full Text]
• Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence Data: Diabetes. June 7, 2006. Available at: http://apps.nccd.cdc.gov/brfss/list.asp?cat=DB&yr=2005&qkey=1363&state=All. Accessed September 14, 2006.
• Centers for Medicare & Medicaid Services. CMS National Measurement Specifications: Diabetes Quality of Care Measures. Baltimore, MD: Centers for Medicare & Medicaid Services; 2002.
• Morris AD, McAlpine R., Steinke D., et al. Diabetes and lower-limb amputations in the community. A retrospective cohort study. DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland/Medicines Monitoring Unit. Diabetes Care. 1998;21:738-743.[Abstract]
• Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA. 2003;289:305-312.[Abstract/Free Full Text]
• Rollow W., Lied T., McGann P., et al. Assessment of the Medicare Quality Improvement Organization Program. Ann Intern Med. 2006;145:342-353.[Abstract/Free Full Text]

American Journal of Medical Quality, Vol. 22, No. 6, 410-417 (2007)
DOI: 10.1177/1062860607304991


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

This article has been cited by other articles:

				M. M. Ward Access to Care and the Incidence of End-Stage Renal Disease Due to Diabetes Diabetes Care, June 1, 2009; 32(6): 1032 - 1036. [Abstract] [Full Text] [PDF]

				K. Sheikh Letter to the Editor: Quality of Ambulatory Care for Diabetes and Lower-Extremity Amputation American Journal of Medical Quality, June 1, 2008; 23(3): 239 - 240. [PDF]

This Article Abstract Free Full Text (Free PDF) Free 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 Web of Science 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 Schade, C. P. Articles by Hannah, K. L. Search for Related Content PubMed PubMed Citation Articles by Schade, C. P. Articles by Hannah, K. L. Pubmed/NCBI databases Medline Plus Health Information Diabetes Complications Social Bookmarking                         What's this?