Physician Process and Patient Outcome Measures for Diabetes Care

Ward, Marcia M.; Yankey, Jon; Vaughn, Thomas; BootsMiller, Bonnie J.; Flach, Stephen D.; Welke, Karl F.; Pendergast, Jane; Perlin, Jonathan B.; Doebbeling, Bradley N.

doi:10.1097/01.mlr.0000135809.92048.d9

Cited by 38 publications

(43 citation statements)

References 46 publications

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“…A study in the American Veterans' Administration found that the availability of a "champion" for use of clinical guidelines and the distribution of audit results to primary providers were associated with better processes of care. They also found that feedback to providers and grand rounds presentations were associated with improved patient intermediate outcomes (10). As a result of SDPI funding, diabetes coordinators and teams at each facility act as "champions" and facilitate distribution of audit results to clinical providers.…”

Section: Discussionmentioning

confidence: 99%

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Ramesh

Schraer

Mayer

et al. 2008

International Journal of Circumpolar Health

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Objectives. The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. Study Design. We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. Methods. We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). Results. Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. Conclusions. SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy. (Int J Circumpolar Health 2008; 67(2-3):203-212)

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Section: Discussionmentioning

confidence: 99%

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Ramesh

Schraer

Mayer

et al. 2008

International Journal of Circumpolar Health

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“…Singh & Kalavar (213) reported similar findings. Ward et al (256) observed that the VA's better adherence with diabetes care guidelines was associated with frequent feedback to frontline caregivers, more effective communication between physicians and nurses, and other organizational characteristics. Proper management of diabetes is especially important for the VA because more than 25% of its patients are diabetic, and this population has an exceptionally high rate of comorbidity and use of health care services (10).…”

Section: Wwwannualreviewsorg • Extreme Makeovermentioning

confidence: 99%

Extreme Makeover: Transformation of the Veterans Health Care System

Kizer¹,

Dudley

2009

Annu. Rev. Public Health

153

130

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The veterans health care system administered by the U.S. Department of Veterans Affairs (VA) was established after World War I to provide health care for veterans who suffered from conditions related to their military service. It has grown to be the nation's largest integrated health care system.As the system grew, a number of factors contributed to its becoming increasingly dysfunctional. By the mid-1990s, VA health care was widely criticized for providing fragmented and disjointed care of unpredictable and irregular quality, which was expensive, difficult to access, and insensitive to individual needs.Between 1995 and 1999, the VA health care system was reengineered, focusing especially on management accountability, care coordination, quality improvement, resource allocation, and information management. Numerous systemic changes were implemented, producing dramatically improved quality, service, and operational efficiency. VA health care is now considered among the best in America, and the VA transformation is viewed as a model for health care reform.

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“…Thirty-five percent of the participants in a community-based study did not follow the vision care guidelines (9). Among the 109 Veterans Affairs medical centers, adherence to the annual eye screening recommendation varies from 48 to 93% (mean Ϯ SD 69.1 Ϯ 10.3%) (10). Only 54% of the patients with diabetes in the Walter Reed Health Care System receive an annual retinal examination.…”

mentioning

confidence: 99%

The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging in Detecting Diabetic Retinopathy

et al. 2006

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OBJECTIVE -The objective of this study was to determine the sensitivity and specificity of Joslin Vision Network nonmydriatic digital stereoscopic retinal imaging (NMDSRI) as a screening tool in detecting diabetic retinopathy.RESEARCH DESIGN AND METHODS -We reviewed the records of 244 patients with diabetes who had a dilated funduscopic examination (DFE) and NMDSRI done within 1 year of each other at four locations in the metropolitan Washington, DC, area. The images were transmitted through a local area network to a central reading location where they were graded by a single retinal specialist.RESULTS -Images of 482 eyes from 243 patients were included in the study. Four images did not transmit, and 35% of the images were not gradable. Of the remaining 311 eyes, there was 86% agreement in the grading between NMDSRI and DFE: 227 eyes with no diabetic retinopathy and 40 eyes with diabetic retinopathy. In 46 eyes (15%) there was a disagreement between gradings made by the two techniques. NMDSRI detected diabetic retinopathy in 35 eyes reported as normal by DFE, and in the remaining 11 eyes, the DFE grade was one grade higher than the NMDSRI grade. Adjudicated nonconcordant examinations were within one grade. In the 76 eyes with diabetic retinopathy, retinal thickness could not be assessed in 17 (21%) eyes. When the NMDSRI result was gradable, the overall sensitivity of NMDSRI was 98% and the specificity was 100% for retinopathy within one grade of the DFE. In the limited number of eyes that had diabetic retinopathy with macular edema (six), agreement with the clinical examination was 100%.CONCLUSIONS -NMDSRI is a sensitive and specific method for the screening and diagnosis of diabetic retinopathy, which may help improve compliance with the standards of eye care for patients with diabetes. Diabetes Care 29:2205-2209, 2006D iabetes is the leading cause of new cases of blindness among adults aged 20 -74 years with diabetic retinopathy, causing as many as 24,000 new cases of blindness per year (1). Crude prevalence rates of diabetic retinopathy and vision-threatening retinopathy in adults Ն40 years of age are 40.3 and 8.2%, respectively (2). In those with type 1 diabetes, the crude prevalences of any diabetic retinopathy were 74.9 versus 82.3% in black and white individuals, respectively, and of vision-threatening retinopathy were 30.0 versus 32.2%, respectively (3). Because the prevalence of diabetes is projected to increase by 35% worldwide between the years 1995 and 2025 (4), the number of Americans with blindness and significant visual impairment will probably rise as well. The high incidence of visual loss and the fact that even severe diabetic retinopathy may be asymptomatic provide strong support for screening (5). The Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS) showed that early treatment can reduce an individual's risk of severe vision loss by 57% (6,7). Moreover, focal laser photocoagulation for diabetic macular edema can reduce the risk of moderate vision los...

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Physician Process and Patient Outcome Measures for Diabetes Care

Abstract: Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.

Cited by 38 publications

References 46 publications

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Extreme Makeover: Transformation of the Veterans Health Care System

The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging in Detecting Diabetic Retinopathy

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