Is the quality of diabetes care better in a diabetes clinic or in a general medicine clinic?
OBJECTIVE
To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center.


METHODS
This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit.


RESULTS
The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02).


CONCLUSIONS
Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.
Ho
M
M
General Internal Medicine Section, West Los Angeles Veterans Affairs Medical Center, CA 90073, USA.
Marger
M
M
Beart
J
J
Yip
I
I
Shekelle
P
P
D015190:Blood Glucose Self-Monitoring; D001795:Blood Pressure Determination; D002140:California; D003920:Diabetes Mellitus / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D017408:Guidelines as Topic; D006785:Hospitals, University; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008487:Medical History Taking; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010349:Patient Compliance; D010808:Physical Examination; D011507:Proteinuria; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents