Quality of care for diabetic patients in a large urban public hospital.
OBJECTIVE
We compared diabetes quality-of-care indicators for patients receiving medical treatment in three practice settings of the same hospital.


METHODS
A cross-sectional medical record review for patients receiving care between 1 July 2000 and 30 June 2001 was conducted. Records were abstracted from three practice settings: the Diabetes Clinic (DIABETES), a general medicine clinic staffed by internal medicine residents (RESIDENT), and a general medicine clinic whose providers were medical school faculty physicians (FACULTY). Record review (n = 791) yielded data on diabetes indicators that were derived primarily from the Diabetes Quality Improvement Project.


RESULTS
There were significant differences between the DIABETES, RESIDENT, and FACULTY clinics for the percentages of patients with HbA(1c) testing (94 vs. 92 vs. 76%, P < 0.001), HbA(1c) >9.5% (31 vs. 36 vs. 43%, P < 0.05), nephropathy assessment (79 vs. 67 vs. 58%, P < 0.001), lipid assessment (86 vs. 79 vs. 76%, P < 0.050), LDL <130 mg/dl (54 vs. 44 vs. 43%, P < 0.05), blood pressure <140/90 mmHg (63 vs. 55 vs. 49%, P < 0.025), eye examinations (64 vs. 50 vs. 31%, P < 0.001), foot examinations (97 vs. 55 vs. 24%, P < 0.001), ACE inhibitor treatment (66 vs. 69 vs. 35%, P < 0.001), and aspirin treatment (71 vs. 59 vs. 15%, P < 0.001).


CONCLUSIONS
There is considerable variation in diabetes management in different primary care settings of the same hospital. Although management in all settings was suboptimal, the results attained by the patients in the Diabetes Clinic represent minimal achievable goals for all diabetic patients in this hospital.
Suwattee
Pitiporn
P
Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
Lynch
J Christopher
JC
Pendergrass
Merri L
ML
D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D019468:Disease Management; D005180:Faculty, Medical / Q000706:statistics & numerical data; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D010349:Patient Compliance; D011787:Quality of Health Care; D017664:Uncompensated Care