QUALITY OF OUTPATIENT CARE PROVIDED TO DIABETIC-PATIENTS - A HEALTH MAINTENANCE ORGANIZATION EXPERIENCE

OBJECTIVE - To document the quality of diabetes care provided to patie nts in a large health maintenance organization (HMO) from 1 January 19 93 to 1 January 1994 and compare it to the standards of the American D iabetes Association (ADA). RESEARCH DESIGN AND METHODS - To meet a Hea lth Plan and Employer Data Information Set (HEDIS) requirement, a majo r HMO in California identified 14,539 members with diabetes and random ly selected 384 individuals for review. Charts were available on 353 o f these patients, and after obtaining the information for the HEDIS re view, additional information was extracted from the charts by an outsi de chart reviewer. This data set was used for an analysts of the quali ty oi diabetic care provided by the participating medical groups to th ese HMO members during 1 year Documentation of follow-up and measures of glycemic and lipid control was examined both for absolute values an d for the frequency of measurement over the year. These results were c ompared to the ADA standards oi care.RESULTS - Although patients avera ged 4.5 visits to their primary care physicians (PCPs) over the year, 21% had one or fewer visits per year. Glycated hemoglobin levels were not documented in 56% of patients (ADA recommends two to four measurem ents per year), and of those with a glycated hemoglobin level measured , 39% had at least one value greater than or equal to 10%. Fasting pla sma glucose concentrations were not documented in 65% of patients (fou r to six per year recommended). Foot exams (which should be performed at each regular visit) were not documented for 94% of patients. Urine protein measurements were not performed in 52% of patients. Additional ly, many patients had elevated and untreated lipid abnormalities. CONC LUSIONS - In spite of the frequency of PCP visits during the year for many of these patients, diabetes management was inadequate. This lack of adequate preventive care will lead to an increased risk of the deve lopment of the acute and chronic complications of diabetes, creating a n even greater future burden on the health care system and negative co nsequences for patients.