Quality of Care for Diabetic Patients in a Large Urban Public Hospital
- 1Tulane University Health Sciences Center, New Orleans, Louisiana
- 2University of Louisiana at Monroe, Monroe, Louisiana
OBJECTIVE—We compared diabetes quality-of-care indicators for patients receiving medical treatment in three practice settings of the same hospital.
RESEARCH DESIGN AND METHODS—A cross-sectional medical record review for patients receiving care between 1 July 2000 and 30 June 2001 was conducted. Records were abstracted from three practice settings: the Diabetes Clinic (DIABETES), a general medicine clinic staffed by internal medicine residents (RESIDENT), and a general medicine clinic whose providers were medical school faculty physicians (FACULTY). Record review (n = 791) yielded data on diabetes indicators that were derived primarily from the Diabetes Quality Improvement Project.
RESULTS—There were significant differences between the DIABETES, RESIDENT, and FACULTY clinics for the percentages of patients with HbA1c testing (94 vs. 92 vs. 76%, P < 0.001), HbA1c >9.5% (31 vs. 36 vs. 43%, P < 0.05), nephropathy assessment (79 vs. 67 vs. 58%, P < 0.001), lipid assessment (86 vs. 79 vs. 76%, P < 0.050), LDL <130 mg/dl (54 vs. 44 vs. 43%, P < 0.05), blood pressure <140/90 mmHg (63 vs. 55 vs. 49%, P < 0.025), eye examinations (64 vs. 50 vs. 31%, P < 0.001), foot examinations (97 vs. 55 vs. 24%, P < 0.001), ACE inhibitor treatment (66 vs. 69 vs. 35%, P < 0.001), and aspirin treatment (71 vs. 59 vs. 15%, P < 0.001).
CONCLUSIONS—There is considerable variation in diabetes management in different primary care settings of the same hospital. Although management in all settings was suboptimal, the results attained by the patients in the Diabetes Clinic represent minimal achievable goals for all diabetic patients in this hospital.
- DIABETES, the Diabetes Clinic
- FACULTY, a general medicine clinic whose providers were medical school faculty physicians
- DQIP, Diabetes Quality Improvement Project
- MCLNO, Medical Center of Louisiana-New Orleans
- PRP, Provider Recognition Program
- RESIDENT, a general medicine clinic staffed by internal medicine residents
Address correspondence and reprint requests to Merri L. Pendergrass, MD, PhD, Department of Medicine, Section of Endocrinology and Metabolism, Tulane University Health Sciences Center, 1430 Tulane Ave., New Orleans, LA 70112. E-mail:.
Received for publication 10 July 2002 and accepted in revised form 12 December 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE