A comparison of diabetes patient's self-reported health status with hemoglobin A1c test results in 11 California health plans.
OBJECTIVE
To examine the relationship between hemoglobin A1c (HbA1c) test rates and values and various self-reported measures of health status within a sample of diabetes patients drawn from 11 California health plans, with a focus on improving diabetes care in this patient population.


METHODS
The analysis relies on data obtained from medical records of a sample population of 4,747 diabetes patients and a patient survey mailed to a large subsample of patients included in the medical-records analysis.


METHODS
Descriptive methods were used to compare the medical records and survey-data results.


RESULTS
There were substantive differences noted between diabetes patients' self-reported health status, their level of satisfaction with the care they received, and the actual care they received. There was a large discrepancy between diabetes patients' perceptions of the care they received for their diabetes, which was overwhelmingly positive, and the HbA1c test-frequency rates observed across the 11 health plans studied, which were low.


CONCLUSIONS
Patients' self-reports of health status, satisfaction with care, and extent of control over diabetes--a chronic condition that may have few perceptible symptoms--are associated with significant methodological limitations. Our examination of the relationship between perceived levels of self-management of diabetes and test status indicated that for patients who had at least one HbA1c test, some education during that process may have resulted in behavioral change. Patients who received no tests, however, may remain unaware of their glycemic control and the long-term consequences associated with even mild hyperglycemia. A clear need thus exists to educate diabetes patients about their health status. Health plan and provider group investments in educational efforts aimed at increasing testing rates are likely to lead to improved glycemic control and a reduction in the incidence of diabetes-related complications and related expenditures.
Wasserman
J
J
Medstat Group, 5425 Hollister Avenue, Suite 140, Santa Barbara, Calif. 93111-2348, USA. jeffrey@rand.org
Boyce-Smith
G
G
Hopkins
D S
DS
Schabert
V
V
Davidson
M B
MB
Ozminkowski
R J
RJ
Albright
A
A
Kennedy
S
S
D002140:California; D003625:Data Collection; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis*; D006304:Health Status; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012647:Self-Assessment
D006442:Glycated Hemoglobin