Objectives: Using administrative data, determine the percentage of diabetic members who received recommended preventive services and identify issues that may affect the reliability of each quality indicator.
Methods: Professional and outpatient facility claims incurred during 1997 were used to identify members with diabetes mellitus. For each quality indicator, members that met criteria for continuous membership, age, and benefits were selected. Rates for 1/1/98-12/31/98 were calculated and intergroup differences were tested for significance. The medical records of a sample of the study population were reviewed to validate the study methodology and identify discrepancies between administrative data and medical record documentation.
Results:
|
Quality Indicator |
Age Group (n) |
Rate |
|
Glycosylated Hemoglobin (HbA1c) Testing |
ages 1-64 (n=50,834) |
|
|
- minimum of 1 test |
|
58% |
|
- 2 or more tests |
|
33% |
|
Monitoring for Nephropathy |
ages 18-64 (n=49,762) |
16% |
|
Assessment of Lipid Profile |
ages 18-64 (n=49,762) |
45% |
|
Eye Examination |
ages 18-64 (n=3,189) |
29% |
|
Influenza Immunization |
ages 1-64 (n=1,275) |
18% |
Conclusions: Since optimal performance of these services would be 100%, the data suggest underutilization of recommended services. However, for three of the measures (lipid profile, eye examination and influenza immunization) benefit, payment, and/or data constraints were identified that could influence the rates. Although analysis revealed significant variation by population characteristics, the overall low rates justify global interventions to improve the management of diabetes. Ongoing collaborative interventions with health systems, provider groups, medical societies, employer groups and community coalitions have focused on improving the quality of care for patients with diabetes mellitus.
Learning Objectives: Identify indicators of quality diabetes management that can be measured with administrative data and describe collaborative interventions that use this data to improve the care provided to patients with diabetes mellitus
Keywords: Diabetes, Disease Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.