Quality of diabetes care among low-income patients in North Carolina

Background: Diabetes is a leading cause of death and disability, disproport ionately affecting most ethnic minority groups, people of low socioeconomic status, the elderly, and people in rural areas. Despite the availability o f evidence-based clinical recommendations, barriers exist in the delivery o f appropriate diabetes care. The purpose of this study is to examine the le vel of diabetes care among low-income populations in North Carolina. Methods: Baseline medical record abstractions were performed (N = 429) on d iabetic patients at 11 agencies serving low-income populations (community h ealth centers, free clinics, primary care clinics, and public health clinic s) across the state participating in a quality-of-diabetes-care initiative. Data were collected for four process (measurement of glycosylated hemoglob in and lipids, dilated eye examination, nephropathy assessment) and two out come glycemic and lipid control measures based on the Diabetes Quality Impr ovement Project (DQIP) and the Health Plan Employer Data and Information Se t (HEDIS), and three additional indicators (blood pressure measurement and control, and lower limb assessment). Compliance rates to individual measure s were calculated overall and by demographic and health characteristics. Results: Diabetes care compliance rates ranged from 77.9% for blood pressur e testing to 3.3% for complete foot examinations. Differences in care were observed by age, insulin use, and prevalent disease. Conclusions: This study indicates low compliance with diabetes care guideli nes in underserved North Carolinians, and inconsistency of care according t o some demographic and health characteristics. These results stress the nee d for quality improvement initiatives that enhance the level of care receiv ed by patients with diabetes, particularly those most vulnerable to diabete s and its complications. (C) 2001 American Journal of Preventive Medicine.