Physician process and patient outcome measures for diabetes care: relationships to organizational characteristics.
BACKGROUND
Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes.


OBJECTIVE
To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes.


METHODS
Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers.


METHODS
We sampled 109 Veterans Affairs medical centers (VAMCs).


RESULTS
Analyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients.


CONCLUSIONS
Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.
Department of Health Management and Policy, University of Iowa, Iowa City, Iowa 52242-1008, USA. marcia-m-ward@uiowa.edu
Marcia M
MM
Ward
Jon W
JW
Yankey
Thomas E
TE
Vaughn
Bonnie J
BJ
BootsMiller
Stephen D
SD
Flach
Karl F
KF
Welke
Jane F
JF
Pendergast
Jonathan
J
Perlin
Bradley N
BN
Doebbeling
D000368:Aged; D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data