Objective: To examine the level of care received by elderly diabetics on Medicare and to evaluate conformity to the recommended practice guidelines.
Study Design: Data were from the 1996 Medicare Current Beneficiary Survey (MCBS). Health care utilization was obtained from the claims data associated with this sample (physician/supplier, inpatient, outpatient, home health). Seven measures recommended by the American Diabetes Association were used to assess the level of care diabetics were receiving: urinalysis, lipid testing, blood glucose measurement, physician examination, hemoglobin A1C, eye examination, and creatinine testing.
Results: Elderly diabetics were not receiving the recommended levels of care. Of the seven measures used for assessing the care provided, urinalysis was conducted the most often (49%). Forty-three percent had eye examinations, 40% had lipid testing, 30% had physical examinations, 25% had blood glucose measurements, 18% had hemoglobin A1C, and 0.6% had creatinine tests. The frequencies of these services varied by several factors, including gender, race, education, income, residence, type of diabetes, and physician specialty.
Conclusions: The care provided to Medicare beneficiaries with diabetes does not meet the standards established by the ADA. The type of diabetes the beneficiary has appears to play a significant role in the likelihood of receiving a recommended procedure, indicating that many physicians do not view Type 2 diabetes as seriously as Type 1 diabetes. Development of diabetes disease management programs that focus on the application of clinical practice guidelines to patient management should be encouraged and facilitated. Policies should increase provider awareness and adherence to these guidelines.
Learning Objectives: 1. To assess the level of care received by Medicare beneficiaries with diabetes. 2. To recognize that elderly diabetics are receiving sub-optimal care
Keywords: Diabetes, Health Care Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.