Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment?

Diabetes Care
Leonard M PogachDavid C Aron

Abstract

To evaluate facility rankings in achieving <7% A1C levels based on the complexity of glycemic treatment regimens using threshold and continuous measures. We conducted a retrospective administrative data analysis of Veterans Health Administration Medical Centers in 2003-2004. Eligible patients were identified using National Committee for Quality Assurance (NCQA) measure specifications. A complex glycemic regimen (CGR) was defined as receipt of insulin or three oral agents. Facilities were ranked using five ordinal categories based up both z score distribution and statistical significance (P < 0.05). Rankings using the NCQA definition were compared with a subset receiving CGRs using both a <7% threshold and a continuous measure awarding proportional credit for values between 7.9 and <7.0%. Ranking correlation was assessed using the Spearman correlation coefficient. A total of 203,302 patients (mean age 55.2 years) were identified from 127 facilities (range 480-5,411, mean 1,601); 26.7% (17.9-35.2%) were receiving CGRs, including 22.0% receiving insulin. Mean A1C and percent achieving A1C <7% were 7.48 and 48% overall and 8.32 and 24.8% for those receiving CGRs using the threshold measure; proportion achieved was 60.1 and 37.2%, r...Continue Reading

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Apr 12, 2012·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Christine T CigolleCaroline S Blaum
Feb 6, 2014·Current Diabetes Reports·David C Aron
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