An Instrumental Variable Analysis of the Impact of Practice Guidelines on Improving Quality of Care and Diabetes-Related Outcomes in the Elderly Medicare Population
- 1 May 2008
- journal article
- research article
- Published by Wolters Kluwer Health in American Journal of Medical Quality
- Vol. 23 (3) , 222-230
- https://doi.org/10.1177/1062860608314940
Abstract
The effect of the diabetes practice guideline recommending ≥2 HbA1c tests annually on diabetes-related outcomes was evaluated using Medicare claims data. The study population included 1998 and 1999 incident diabetes patients aged ≥ 67 years, who were Medicare eligible and without known diabetes-related complications at baseline. Number of HbA1c tests was measured 1 year after diabetes incidence. All-cause death and diabetes complications were identified during follow-up, through December 2003. The analysis was conducted with an instrumental variable method and a bivariate probit model, controlling for individual, social, and health care system characteristics. Among 13 033 patients, 27.1% followed the practice guideline. Receiving ≥2 HbA1c tests annually was significantly associated with a decrease in probability of 28.8 percentage points for macrovascular complications, 28.7 for atherosclerotic heart disease, and 23.1 for chronic kidney disease or end-stage renal disease in the 4-year follow-up period. (Am J Med Qual 2008;23: 222-230)Keywords
This publication has 14 references indexed in Scilit:
- Pioglitazone Inhibits Cell Growth and Reduces Matrix Production in Human Kidney FibroblastsJournal of the American Society of Nephrology, 2005
- Was Breast Conserving Surgery Underutilized for Early Stage Breast Cancer? Instrumental Variables Evidence for Stage II Patients from IowaHealth Services Research, 2003
- Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 DiabetesNew England Journal of Medicine, 2003
- Evaluation of Innovative Skin-Marking Technique Performed Before Thyroid Ultrasound-Guided Fine-Needle Aspiration BiopsiesEndocrine Practice, 2002
- Identifying Persons with Diabetes Using Medicare Claims DataAmerican Journal of Medical Quality, 1999
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- ECONOMETRICS IN OUTCOMES RESEARCH: The Use of Instrumental VariablesAnnual Review of Public Health, 1998
- Gender Economics Courses in Liberal Arts Colleges: Further ResultsThe Journal of Economic Education, 1998
- Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality?JAMA, 1994
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1993