The 130th Annual Meeting of APHA

Abstract #46944

Charles P. Schade, MD, MPH, West Virginia Medical Institute, 3001 Chesterfield Place, Charleston, WV 25304, (304) 346-9864 x 2243, cschade@wvmi.org

Background: Two of three claims-based diabetes quality of care indicators for Medicare beneficiaries (glycated hemoglobin [HbA1c] testing and lipid screening) have increased significantly in West Virginia since 1999, but the third (dilated eye examination) has not, in spite of coordinated efforts among the state's peer review organization, public health department, and eye care professionals.

Objective: Determine whether there are characteristics of beneficiaries with diabetes, their physicians, or their health services utilization that might explain the failure of eye examination rates to improve.

Methods: Using a database of outpatient claims for Medicare patients with diabetes in West Virginia, we examined quality indicator rates by beneficiary age, sex, and county of residence for calendar year 2000. We plotted quality indicator rates by week for a 33 month period and assessed time trends of utilization. We also calculated rates by specialty for physicians providing diabetes care to 10 or more persons, and rates by number of physicians seen for diabetes services as well as by total number of diabetes outpatient evaluation and management visits.

Results: Utilization rates of hbA1c and lipid testing increased significantly over time (r=0.515 and r=0.501, respectively; 0.01 Conclusions: Diabetes eye examination rates in West Virginia have changed little since 1998, while rates of hbA1c and lipid testing have increased steadily. HbA1c and lipid testing were much more strongly associated with physician visits for diabetes management than eye examination rates. This suggests that beneficiaries with diabetes were likely to have eye examinations independently of their diabetes care. Increasing these rates may require promoting them directly to patients instead of to their physicians.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• Define three claims-based quality indicators for diabetes care;
• Describe demographic, geographic, and health services utilization factors that may impact measured quality of diabetes care; and
• Explain how differences in characteristics of diabetes health care services might affect choices of methods to promote their use.

Keywords: Diabetes, Quality of Care

Presenting author's disclosure statement:
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.