title: Problems in assessing diabetes control in an ambulatory setting.
abstract: Problems in using medical records to assess outcomes of diabetes care have not been well defined. We reviewed the medical records of 288 patients with diabetes receiving ambulatory care over a 2-year period. We determined the availability of different tests of glycemic control and described site performance as the percentage of patients with a blood glucose exceeding either 180 or 240 mg/dl. Glycosylated hemoglobin determinations were performed in only 26.7% of patients. A blood glucose was available in 208 patients (72.2%) during a 6-month outcome period. For almost 50% of the sample, the glucose was greater than 180 mg/dl, whereas in 20% it exceeded 240 mg/dl. Judgments of whether sites differed in performance depended on how control was defined. Using a single glucose determination and a threshold of 180 mg/dl, similar fractions of patients were poorly controlled at each site (51.2 versus 45.0 versus 47.0%) (P = 0.75). At 240 mg/dl, although, one site performed much worse than the other two (14.6 versus 16.7 versus 31.8%) (P = 0.02). These results highlight difficulties in defining the outcome measure when using medical records to evaluate quality of care.
authors.affiliation: HSR&D Field Program, Bedford VA Hospital, Bedford, MA 01730, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: A
authors.initials: A
authors.lastname: Ash
authors.forename: R
authors.initials: R
authors.lastname: Friedman
authors.forename: E
authors.initials: E
authors.lastname: Hickey
authors.forename: B
authors.initials: B
authors.lastname: Kader
authors.forename: M A
authors.initials: MA
authors.lastname: Moskowitz
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D001900:Boston; D003920:Diabetes Mellitus / Q000097:blood* / Q000534:rehabilitation; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose