title: Diabetes process and outcome measures in the Department of Veterans Affairs.
abstract: OBJECTIVE
  To evaluate performance of process and outcome measures in the care of patients with diabetes seen in Department of Veterans Affairs (VA) facilities.
  
  
  METHODS
  Retrospective audits of records and databases were conducted on randomly selected patients with diabetes over 5 years (1995 [baseline] and 1997-2000) in 22 VA networks. Performance on diabetes-specific and preventive processes was measured.
  
  
  RESULTS
  Nationally, significant improvements over time were observed for all measures (P < 0.001). For example, the percentage of patients receiving a dilated retinal examination rose from 44% in 1995 to 67% in 2000. The percentage of patients who received a urinary protein test rose from 23% in 1997 to 54% in 2000. Those who received influenza vaccination rose from 34% in 1995 to 78% in 2000. However, there was significant regional variation among all measures.
  
  
  CONCLUSIONS
  Adherence to diabetes-specific and preventive care measures in the VA improved from 1997 to 2000 compared with a 1995 baseline. The improvement occurred in a setting of the provision of guidelines, the contractual setting of specific targets, and the timely feedback of results to medical center and network directors. Future studies are needed to determine whether adherence to these measures will decrease the rates of complications in VA patients with diabetes.
authors.affiliation: Office of the Medical Inspector, Department of Veterans Affairs, Washington, D.C., USA.
authors.forename: Clark T
authors.initials: CT
authors.lastname: Sawin
authors.forename: Debby J
authors.initials: DJ
authors.lastname: Walder
authors.forename: Dean S
authors.initials: DS
authors.lastname: Bross
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Pogach
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D017719:Diabetic Foot / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D011507:Proteinuria; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*
chemical_list: D006442:Glycated Hemoglobin; D008055:Lipids