Where Is the Patient in Diabetes Performance Measures?

Abstract

OBJECTIVE -Health policies are important determinants of clinician and patient behavior, and an important policy issue is what items are included in healthcare quality and performance measures. There is consensus that patient-centered care and self-management support are essential evidence-based components of good diabetes care. However, most major diabetes performance measures such as the National Committee for Quality Assurance (NCQA)/American Diabetes Association (ADA) Provider Recognition Program indexes have not included selfmanagement or psychosocial items. RESEARCH DESIGN AND METHODS AND RESULTS-We review the case for and propose a set of patient-centered, self-management indicators to be included as a standard part of diabetes quality indicators. The proposed indicators include: patient self-management goal(s), measures of health behaviors (e.g., healthy eating, medication taking, physical activity, and smoking status), quality of life, and patient-centered collaborative care. We discuss the evidence and the concerns about patient-report measures and summarize successful incorporation of such patient-centered measures in other countries and by the American Association of Diabetes Educators (AADE).CONCLUSIONS -The adage that "what gets measured, gets done" applies to diabetes management and many other areas of healthcare. Inclusion of the proposed indicators in national diabetes performance measures would be consistent with Institute of Medicine (IOM), ADA, Centers for Disease Control (CDC), Diabetes Attitudes, Wishes, and Needs (DAWN), AADE, and Society of Behavioral Medicine (SBM) recommendations. Such action would enhance both the priority and delivery of quality, patient-centered care, and diabetes self-management support.

The Association Between Patient-Reported Self-management Behavior, Intermediate Clinical Outcomes, and Mortality in Patients With Type 2 Diabetes: Results From the KORA-A Study

“…Further, most importantly, strategies proven to be effective, costeffective, and feasible to implement should be rapidly adapted by health care providers, even though adaptations will require changes in the current system of care and remuneration schemes. In addition, from a scientific perspective, the collection of data about physician-delivered diabetes education and patient-reported SMB should, where possible, be routinely assessed and incorporated into electronic health records, as such data sources are necessary to enhance population-based health services research and to strengthen the patient-centered perspective in health care (38,39).…”

Diabetesbezogene Belastungen, Wohlbefinden und Einstellung von Menschen mit Diabetes

“…Trotz zahlreicher Fortschritte seit der ersten DAWN-Studie gibt es noch immer Wissensdefizite bezüglich der Bedürf-nisse, Einstellungen und Wünsche von Menschen mit Diabetes, die zudem in der Behandlung des Diabetes zu wenig berücksichtigt werden [10,11,12,13]. Dies war der Grund für die Durchführung der zweiten globalen Studie zu psychosozialen Belastungen und Barrieren der Diabetestherapie: DAWN2™ [14].…”

Predicting the consumption of foods low in saturated fats among people diagnosed with Type 2 diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour

“…In line with this focus on self-management, more recent studies have highlighted the importance of goal setting (e.g., Allen, 2004) or self-management goals (e.g., Glasgow et al, 2008) for the adoption of health recommendations among individuals with diabetes. Few studies, however, have provided a theoretical examination of the importance of forming goals or plans in health-related behavioural performance (e.g., physical activity or diet) among individuals with diabetes/CVD (Hardeman,Michie,5 Fanshawe, Prevost, McLoughlin, & Kinmonth, 2008;Michie, Hardeman, Fanshawe, Prevost, Taylor, & Kinmonth, 2008;Williams et al, 2004).…”

“…Given the recent shift in diabetes care from a passive patient care approach to a selfmanagement, patient-centred approach (Glasgow, Peeples, & Skovlund, 2008), examining social cognitive variables (e.g., attitudes, normative support, barriers to dietary self-care; Blue, 2007;Blue & Marrero, 2006) that predict behavioural performance and behavioural change is now even more important, especially for at-risk populations such as individuals diagnosed with Type 2 diabetes and CVD.…”