Assessment of Diabetes Care by Medical Record Review: The Indian Health Service Model

Jennifer A Mayfield; Stephen J Rith-Najarean; Kelly J Acton; Cynthia D Schraer; Ruggles M Stahn; Mildred H Johnson; Dorothy Gohdes

doi:10.2337/diacare.17.8.918

Special Articles

Assessment of Diabetes Care by Medical Record Review: The Indian Health Service Model

Jennifer A Mayfield, MD, MPH,
Stephen J Rith-Najarean, MD,
Kelly J Acton, MD,
Cynthia D Schraer, MD,
Ruggles M Stahn, MD, MPH,
Mildred H Johnson, RNC, MN, CDE and
Dorothy Gohdes, MD

Department of Family Medicine, Bowen Research Center, Indiana University Indianapolis, Indiana
Bemidji Area Indian Health Service Bemidji, Minnesota
Flathead Health Center, St. Ignatius Montana
Alaska Native Diabetes Program Anchorage, Alaska
Epidemiology Department, Public Health Service Indian Hospital Rapid City, South Dakota
Public Health Service Indian Hospital Sells, Arizona
Indian Health Service Diabetes Program Albuquerque, New Mexico

Address correspondence and reprint requests to Jennifer A. Mayfield, MD, Bowen Research Center, Department of Family Medicine, Indiana University, Purdue University at Indianapolis, Long Hospital, 1110 West Michigan Street, Indianapolis, IN 46202 or to Dorothy Gohdes, MD, Indian Health Service Diabetes Program, 5300 Homestead Road NE, Albuquerque, NM 87110.

Diabetes Care 1994 Aug; 17(8): 918-923. https://doi.org/10.2337/diacare.17.8.918

Abstract

OBJECTIVE To evaluate the adherence to minimum standards for diabetes care in multiple primary-care facilities using a uniform system of medical record review.

RESEARCH DESIGN AND METHODS In 1986, the Indian Health Service (IHS) developed diabetes care standards and an assessment process to evaluate adherence to those standards using medical record review. We review our assessment method and results for 1992. Charts were selected in a systematic random fashion from 138 participating facilities. Trained professional stai reviewed patient charts, using a uniform set of definitions. A weighted rate of adherence was constructed for each item.

RESULTS Medical record reviews were conducted on 6,959 charts selected from 40,118 diabetic patients. High rates of adherence (>70%) were noted for blood pressureand weight measurements at each visit, blood sugar determinations at each visit, annual laboratory screening tests, electrocardiogram at baseline, and adult immunizations. Lower rates of adherence (≤50%) were noted for annual eye, foot, and dental examinations.

CONCLUSIONS IHS rates of adherence are similar to rates obtained from medical record reviews and computerized billing data, but are less than rates obtained by provider self-report. Medical record review, using uniform definitions and inexpensive software for data entry and reports, can easily be implemented in multiple primary-care settings. Uniformity of data definition and collection facilitates the aggregation of the data and comparison over time and among facilities. This medical record review system, although labor intensive, can be easily adopted in a variety of primary-care settings for quality improvement activities, program planning, and evaluation.