title: Quality of care of Medicare patients with diabetes in a metropolitan fee-for-service primary care integrated delivery system.
abstract: Diabetes care in the United States is suboptimal. Although closed-panel health maintenance organizations (HMOs) and the Department of Veterans Affairs (VA) report performance superior to national norms, fee-for-service performance is uncertain. To address this issue, 3 outcome and 5 process indicators were measured for 2010 Medicare diabetes patients across 22 sites in a large, fee-for-service primary care group practice. American Diabetes Association standards for glycemic control, low-density lipoprotein cholesterol, and blood pressure were met by 53%, 46%, and 19% of patients, respectively. Diabetes Quality Improvement Project/Alliance poor control markers for the same measures were exceeded by 9%, 20%, and 54% of patients. Chart abstraction demonstrated annual eye examination, foot examination, and nephropathy screening rates of 16%, 49%, and 38%, while Medicare claims showed an annual eye examination rate of 63%. Observed processes and outcomes in this fee-for-service setting were superior to reported national performance and similar to the best performance in staff-model HMOs and the VA.
authors.affiliation: Baylor-Ruth Collins Diabetes Center, Baylor University Medical Center, Baylor Health Care System, 8080 North Central Expressway, Dallas, TX 75206, USA.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Hollander
authors.forename: David
authors.initials: D
authors.lastname: Nicewander
authors.forename: Carl
authors.initials: C
authors.lastname: Couch
authors.forename: David
authors.initials: D
authors.lastname: Winter
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Ziad
authors.initials: Z
authors.lastname: Haydar
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy*; D018588:Fee-for-Service Plans / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013781:Texas