Applying the Diabetes Quality Improvement Project Indicators in the IndianHealth Service primary care setting

OBJECTIVE - With publication of the Diabetes Quality Improvement Project (D QIP) measures, the Indian Health Service National Diabetes Program applied the DQIP format to its IHS Diabetes Care and Outcomes Audit for comparison and benchmarks. RESEARCH DESIGN AND METHODS - since 1986 the IHS Diabetes Care and Outcomes Audit has been conducted by medical record review in >75% of IHS and triba l facilities. Each year systematic random sample of charts is drawn from lo cal diabetes registries. Chart reviews are conducted by trained professiona ls according to standard definitions and instructions. Abstracted data are entered into a microcomputer-based epidemiologic software package. Local, r egional, and national rates are constructed for each item. During the perio d 1995-1997, 150 facilities submitted data for compilation, representing pa rticipation from all 12 IHS administrative regions. The IHS Diabetes Care a nd Outcomes Audit collected virtually all of the DQIP measures, with the ex ception of LDL cholesterol (which was added to the record review in 1998). RESULTS - In 1995, 1996, and 1997, a total of 9,557, 9,985, and 9,626 indiv iduals, respectively, were included in the total IHS audit sample. The revi ews for 1995, 1996, and 1997 revealed that of all subjects: 55, 65, and 80% , respectively, had more than one HbA(1c) test during the year (P < 0.001); 42, 38, and 34%, respectively, had a high-risk HbA(1c) (>9.5%) (P < 0.001) ; 83, 81, and 84%, respectively, were tested for macroproteinuria (P < 0.11 ) and 16, 17, and 23%, respectively, were tested for microproteinuria (P < 0.001); total cholesterol was assessed in 80, 81, and 85%, respectively (P < 0.001), and corresponding proportions of those with values <5.17 mmol/l w ere 48, 50, and 52%, respectively; triglyceride values were measured for 75 ,75, and 80%, respectively (P < 0.001), and the corresponding median trigly ceride levels were 199, 198, and 191 mg/dl, respectively (P < 0.001); the p roportion of clients with a blood pressure < 140/90 mmHg was 64, 64, and 66 %, respectively (P < 0.05); 55, 56, and 55%, respectively, had a dilated ey e exam (P < 0.053); and the proportion of clients who had a comprehensive f oot exam were 59, 59, and 61%, respectively (P < 0.05). CONCLUSIONS - The DQIP accountability and quality improvement measures coul d be easily applied to the II-Is Diabetes Care and Outcomes Audit, and the process can prove to be practical. However, data alone are not sufficient t o effect change. Use of the measures to ensure that the quality of care imp roves must also be stressed, because measuring alone Rill not guarantee suc h improvement.