Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zhang, Q.
Right arrow Articles by Pogach, L. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zhang, Q.
Right arrow Articles by Pogach, L. M.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Diabetes Care, Vol 23, Issue 7 919-927, Copyright © 2000 by American Diabetes Association

ARTICLES

Performance status of health care facilities changes with risk adjustment of HbA1c

Q Zhang, M Safford, J Ottenweller, G Hawley, D Repke, JF Burgess, S Dhar, H Cheng, H Naito and LM Pogach
Veterans Affairs Medical Center, East Orange, New Jersey 07018, USA.

OBJECTIVE: To develop a risk adjustment method for HbA1c, based solely on administrative data and to determine the extent to which risk-adjusted HbA1c changes the identification of high- or low-performing medical facilities. RESEARCH DESIGN AND METHODS: Through use of pharmacy records, 204,472 diabetic patients were identified for federal fiscal year 1996 (FY96). Complete information (HbA1c levels, demographic data, inpatient records, outpatient pharmacy utilization records) was available on 38,173 predominantly male patients from 48 Veterans Health Administration (VHA) medical facilities. Hierarchical mixed-effects models were used to estimate risk-adjusted unique facility-level HbA1c. RESULTS: Predicted HbA1c demonstrated expected patterns for major factors known to influence glycemic control. Poorer glycemic control was seen in minorities and patients with greater disease severity, longer duration of disease (using treatment type or presence of amputation as surrogates), and more extensive comorbidity (measured by an adapted Charlson index). Better glycemic control was seen in Caucasians, older diabetic patients, and patients with higher outpatient utilization. The number of performance outliers was reduced as a result of risk adjustment. For mean HbA1c levels, 7 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. For high-risk HbA1c (>9.5%) rates, 12 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. CONCLUSIONS: Risk adjustment using only administrative data resulted in substantial changes in identification of high or low performers compared with non-risk-adjusted HbA1c. Although our findings are exploratory, risk adjustment using administrative data may be a necessary and achievable step in quality assessment of diabetes care measured by rates of high-risk HbA1c (>9.5%).
Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Int J Qual Health CareHome page
D. Aron, M. Rajan, and L. M. Pogach
Summary measures of quality of diabetes care: comparison of continuous weighted performance measurement and dichotomous thresholds
Int. J. Qual. Health Care, February 1, 2007; 19(1): 29 - 36.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
L. M. Pogach, M. Rajan, and D. C. Aron
Comparison of Weighted Performance Measurement and Dichotomous Thresholds for Glycemic Control in the Veterans Health Administration
Diabetes Care, February 1, 2006; 29(2): 241 - 246.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
J. K Kirk, R. A Bell, A. G Bertoni, T. A Arcury, S. A Quandt, D. C Goff Jr., and K M V. Narayan
Ethnic Disparities: Control of Glycemia, Blood Pressure, and LDL Cholesterol Among US Adults with Type 2 Diabetes
Ann. Pharmacother., September 1, 2005; 39(9): 1489 - 1501.
[Abstract] [Full Text] [PDF]

Home page
 Am J EpidemiolHome page
C.-L. Tseng, M. Brimacombe, M. Xie, M. Rajan, H. Wang, J. Kolassa, S. Crystal, T.-C. Chen, L. Pogach, and M. Safford
Seasonal Patterns in Monthly Hemoglobin A1c Values
Am. J. Epidemiol., March 15, 2005; 161(6): 565 - 574.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
M. Pladevall, L. K. Williams, L. A. Potts, G. Divine, H. Xi, and J. Elston Lafata
Clinical Outcomes and Adherence to Medications Measured by Claims Data in Patients With Diabetes
Diabetes Care, December 1, 2004; 27(12): 2800 - 2805.
[Abstract] [Full Text] [PDF]

Home page
 American Journal of Medical QualityHome page
V. N. Joish, D. C. Malone, C. Wendel, and M. J. Mohler
Profiling Quality of Diabetes Care in a Veterans Mfairs Healthcare System
American Journal of Medical Quality, May 1, 2004; 19(3): 112 - 120.
[Abstract] [PDF]

Home page
 Diabetes CareHome page
D. A. Helmer, C.-L. Tseng, M. Brimacombe, M. Rajan, N. Stiptzarov, and L. Pogach
Applying Diabetes-Related Prevention Quality Indicators to a National Cohort of Veterans With Diabetes
Diabetes Care, November 1, 2003; 26(11): 3017 - 3023.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
G. D. Schiff, D. Klass, J. Peterson, G. Shah, and D. W. Bates
Linking Laboratory and Pharmacy: Opportunities for Reducing Errors and Improving Care
Arch Intern Med, April 28, 2003; 163(8): 893 - 900.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2000 by the American Diabetes Association.