Effect of quality improvement on racial disparities in diabetes care.
BACKGROUND
Racial disparities in care are well documented; information regarding solutions is limited. We evaluated whether generic quality improvement efforts were associated with changes in racial disparities in diabetes care.


METHODS
Using insurance claims and electronic medical record data, we identified 5101 whites and 1987 blacks with diabetes mellitus receiving care within a multispecialty group practice from 1997 to 2001. We assessed rates of annual low-density lipoprotein cholesterol level testing, low-density lipoprotein cholesterol level control (<130 mg/dL [<3.37 mmol/L]), statin therapy, annual glycosylated hemoglobin level testing, glycosylated hemoglobin level control (<7.0%), and annual dilated eye examinations. We used logistic regression models with generalized estimating equations to adjust for race, year, race x year interactions, age, and sex.


RESULTS
Rates of annual low-density lipoprotein cholesterol level testing increased from 39% to 64%, while the white-black disparity decreased from 14% to 4%; rates of low-density lipoprotein cholesterol level control increased from 15% to 43%, while the white-black disparity decreased from 9% to 6% (P<.001 for both race x year interactions). Statin therapy rates increased from 20% to 37%; however, black patients remained less likely than white patients to receive therapy. The 1997 rates of annual glycosylated hemoglobin level testing (76%) and annual eye examinations (74%) were high, and there was no white-black disparity over time. Rates of glycosylated hemoglobin level control remained low (31%), and the white-black disparity remained constant at 10%.


CONCLUSIONS
Racial disparities were diminished in some aspects of diabetes care following variably successful quality improvement, but differences in the use of statins and glycemic level control persisted. Reducing disparities may require a focus on minority health.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. tsequist@partners.org
Thomas D
TD
Sequist
Alyce
A
Adams
Fang
F
Zhang
Dennis
D
Ross-Degnan
John Z
JZ
Ayanian
D044383:Black People; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000175:diagnosis / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D019468:Disease Management; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011787:Quality of Health Care; D017678:Sex Distribution; D044465:White People; D001741:Black or African American
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors