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APHA Scientific Session and Event Listing

Recorded presentation

Alan D. Krinsky, PhD, Department of Community Health/MPH Program, Brown University, Box G-A4, Providence, RI 02912, 401-724-7643, adkrinsky@netzero.net, Deborah N. Pearlman, PhD, Department of Community Health/MPH Program, Rhode Island Department of Health, Box G-A4, Providence, RI 02912, Joann Lindenmayer, DVM, MPH, Department of Environmental and Population Health, Tufts Cummings School of Veterinary Medicine, Room 115, Bernice Barbour Wildlife Building, 200 Westboro Road, North Grafton, MA 01536, and Christen O'Haire, BA, PhD Candidate, Department of Community Health/Program in Epidemiology, Brown University, Box G-A4, Providence, RI 02912.

BACKGROUND: Most research into diabetes care measures the delivery of individual Clinical Preventive Services (CPS) or Self-Management Practices (SMP), without considering whether individuals with diabetes receive comprehensive diabetes care for all recommended procedures. A public health approach to comprehensive diabetes care would aim to measure the proportion of recommended diabetes procedures received by each individual with diabetes within a population.

OBJECTIVES: The objectives of this study are to measure: (1) the proportion of respondents reporting (a) receipt of each of five CPS: Dilated Eye Exam (DEE), Foot Exam (FEX), Influenza Shot (INF), and two HbA1C Tests (A1C) in the last year, and one Pneumococcal Vaccine (PNV) ever and (b) engaging in each of five SMP: Visit to Doctor for Diabetes (DOC) in the last year, Daily Self-Check of Blood Glucose (GLU), Daily Self-Check of Feet (SCF), Attendance at a Diabetes Education Class (DED) once ever, and Not Smoking (SMK); and (2) the proportion of respondents reporting receipt of zero through five CPS and zero through five SMP.

METHODS: This retrospective, cross-sectional study uses self-reported receipt of CPS and SMP from 768 adults with self-reported diabetes from the 2001-2003 Rhode Island Behavioral Risk Factor Surveillance Surveys. Population estimated parameters were weighted to represent the non-institutionalized, adult, civilian population of Rhode Island. Diabetes quality care indicators were drawn from American Diabetes Association guidelines.

RESULTS: For CPS, 77.13% of respondents reported receiving DEE, 70.32% FEX, 69.99% INF, 60.76% A1C, and 54.97% PNV. For SMP, 90.84% of respondents reported engaging in DOC, 65.69% SCF, 51.50% GLU, 42.95% DED, and 84.70% SMK. For the bundled CPS measures, 21.16% of respondents reported receiving all five, 30.09% four, 22.52% three, 15.75% two, 7.97% one, and 2.51% none. For the bundled SMP measures, 18.44% of respondents reported receiving all five, 27.31% four, 32.03% three, 16.40% two, 5.35% one, and 0.47% none.

DISCUSSION: Most individuals with diabetes report not receiving or engaging in all of the CPS and SMP important to the most effective management of diabetes. Bundling diabetes quality care measures allows for measurement of the degree of comprehensiveness of diabetes care. Measuring comprehensive care can help improve diabetes care in both clinical and public health contexts. Future research should investigate the relationship between CPS and SMP, as well as the relationship between the receipt of comprehensive care and health outcomes for people with diabetes.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Distinguish between clinical preventive services and self-management practices in diabetes care.
• Define what is meant by bundling quality care measures.
• Discuss the concept of comprehensive diabetes care.

Keywords: Quality of Care, Diabetes

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation