Profiling Quality of Diabetes Care in a Veterans Mfairs Healthcare System

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Abstract
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.