Veterans Affairs primary care organizational characteristics associated with better diabetes control.
OBJECTIVE
To examine organizational features of Veterans Affairs (VA) primary care programs hypothesized to be associated with better diabetes control, as indicated by hemoglobin A1C (HbA1C) levels.


METHODS
Cross-sectional cohort.


METHODS
We established a cohort of 224 221 diabetic patients using the VA Diabetes Registry and Dataset and VA corporate databases. The 1999 VHA (Veterans Health Administration) Survey of Primary Care Practices results were combined with individual patient data. A 2-level hierarchical model was used to determine the relationship between organizational characteristics and HbA1C levels in 177 clinics with 82 428 cohort members.


RESULTS
The following attributes were associated with lower (better) HbA1C and were statistically significant at P < .05: greater authority to establish or implement clinical policies (lower by 0.21%), greater staffing authority (0.28%), computerized diabetes reminders (0.17%), notifying all patients of their assigned provider (0.21%), hiring needed new staff during fiscal year 1999 (0.18%), having nurses that report only to the program (0.16%), and being a large academic practice (0.27%). Associated with higher (worse) HbA1C were programs reporting that patients almost always see their assigned provider (greater by 0.18%), having a quality improvement program involving all nurses without all physicians (0.38%), having general internal medicine physicians report only to the program (0.20%), and being located at an acute care hospital (0.20%).


CONCLUSIONS
Programs that are associated with better diabetes control simultaneously have teams that actively involve physicians in quality improvement, use electronic health information systems, have authority to respond to staffing and programmatic issues, and engage patients in care.
Jackson
George L
GL
Health Services Research & Development Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA. george_jackson@alumni.unc.edu
Yano
Elizabeth M
EM
Edelman
David
D
Krein
Sarah L
SL
Ibrahim
Michel A
MA
Carey
Timothy S
TS
Lee
Shoou-Yih Daniel
SY
Hartmann
Katherine E
KE
Dudley
Tara K
TK
Weinberger
Morris
M
D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003625:Data Collection; D003920:Diabetes Mellitus; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs
D006442:Glycated Hemoglobin