Comparison of Laboratory Test Frequency and Test Results Between African-Americans and Caucasians With Diabetes: Opportunity for Improvement: Findings from a large urban health maintenance organization
- Kimberlydawn Wisdom, MD, MS,
- Jon P Fryzek, PHD,
- Suzanne L Havstad, MA,
- Robert M Anderson, EDD,
- Michael C Dreiling, MA and
- Barbara C Tilley, PHD
- Henry Ford Health System, University of Nebraska Medical Center Omaha, Nebraska
- Center for Medical Treatment Effectiveness Programs Detroit Department of Postgraduate Medicine and Health Professions Education, University of Nebraska Medical Center Omaha, Nebraska
- University of Michigan Medical School Ann Arbor, Michigan Department of Preventive and Societal Medicine, University of Nebraska Medical Center Omaha, Nebraska
- Address correspondence and reprint requests to Kimberlydawn Wisdom, MD, MS, Henry Ford Health Sciences Center, Center for Medical Treatment Effectiveness Programs, One Ford Place, Suite 3E, Detroit, MI 48202. E-mail: kwisdoml{at}biostat.hfh.edu
Abstract
OBJECTIVE To compare African-American and Caucasian patients with preexisting diabetes in a health maintenance organization (HMO) on: 1) frequency with which they received a subset of recommended laboratory tests according to the American Diabetes Association (ADA) consensus guidelines and 2) the results of laboratory test values (glycosylated hemoglobin, cholesterol, and creatinine).
RESEARCH DESIGN AND METHODS A cross-sectional study of 2,312 HMO members with diabetes continuously enrolled during 1991 was conducted using computerized medical record and billing data. Receipt of the ADA recommended tests for glycosylated hemoglobin, cholesterol, and creatinine was compared between African-Americans and Caucasians, stratified by insulin requirements. In addition, group comparisons were made based on the laboratory test results.
RESULTS Less than 20 percent of all subjects received the recommended number of ADA tests. This did not differ by race except for creatinine and cholesterol testing in insulin users only, where African-Americans had more tests. On average, after adjusting for covariates, African-Americans had significantly higher glycosylated hemoglobin and creatinine laboratory values. Both groups had elevated cholesterol values.
CONCLUSIONS The opportunity exists to improve the process of care for both African-Americans and Caucasians with diabetes in an HMO setting. The need to improve glycosylated hemoglobin results and subsequently limit complications is especially pressing among the African-American population.
- Received December 19, 1995.
- Accepted December 30, 1996.
- Copyright © 1997 by the American Diabetes Association
