title: Diabetes outcomes in the Indian health system during the era of the Special Diabetes Program for Indians and the Government Performance and Results Act.
abstract: OBJECTIVE
  We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system.
  
  
  METHODS
  We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit.
  
  
  RESULTS
  Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively.
  
  
  CONCLUSIONS
  We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals.
authors.affiliation: Indian Health Service, Phoenix Indian Medical Center, 4212 N 16th St, Phoenix, AZ 85016, USA. charlton.wilson@ihs.gov
authors.forename: Charlton
authors.initials: C
authors.lastname: Wilson
authors.forename: Susan
authors.initials: S
authors.lastname: Gilliland
authors.forename: Theresa
authors.initials: T
authors.lastname: Cullen
authors.forename: Kelly
authors.initials: K
authors.lastname: Moore
authors.forename: Yvette
authors.initials: Y
authors.lastname: Roubideaux
authors.forename: Lorraine
authors.initials: L
authors.lastname: Valdez
authors.forename: William
authors.initials: W
authors.lastname: Vanderwagen
authors.forename: Kelly
authors.initials: K
authors.lastname: Acton
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006078:Government Programs / Q000592:standards*; D006801:Humans; D007198:Indians, North American; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D014481:United States; D016549:United States Indian Health Service / Q000592:standards*
chemical_list: D006442:Glycated Hemoglobin