ASSESSMENT AT DIABETES CARE BY MEDICAL RECORD REVIEW - THE INDIAN HEALTH-SERVICE MODEL

OBJECTIVE - To evaluate the adherence to minimum standards for diabete s care in multiple primary-care facilities using a uniform system of m edical record review. RESEARCH DESIGN AND METHODS - In 1986, the India n Health Service (IHS) developed diabetes care standards and an assess ment process to evaluate adherence to those standards using medical re cord review. We review our assessment method and results for 1992. Cha rts were selected in a systematic random fashion from 138 participatin g facilities. Trained professional staff reviewed patient charts, usin g a uniform set of definitions. A weighted rate of adherence was const ructed for each item. RESULTS - Medical record reviews were conducted on 6,959 charts selected from 40,118 diabetic patients. High rates of adherence (> 70%) were noted for blood pressure and weight measurement s at each visit, blood sugar determinations at each visit, annual labo ratory screening tests, electrocardiogram at baseline, and adult immun izations. Lower rates of adherence (less than or equal to 50%) were no ted for annual eye, foot, and dental examinations. CONCLUSIONS - IHS r ates of adherence are similar to rates obtained from medical record re views and computerized billing data, but are less than rates obtained by provider self-report. Medical record review, using uniform definiti ons and inexpensive software for data entry and reports, can easily be implemented in multiple primary-care settings. Uniformity of data def inition and collection facilitates the aggregation of the data and com parison over time and among facilities. This medical record review sys tem, although labor intensive, can be easily adopted in a variety of p rimary-care settings for quality improvement activities, program plann ing, and evaluation.