title: Measuring the quality of diabetes care in urban and rural Indian health programs.
abstract: OBJECTIVE
  The purpose of this study was to compare the quality of diabetes care provided to American Indians/Alaska Natives (AI/AN) by urban and rural Indian health programs.
  
  
  METHODS
  Medical record review data collected by the Indian Health Service as part of the Diabetes Care and Outcomes Audit in 2002.
  
  
  METHODS
  Seventeen urban Indian health clinics and 225 rural Indian health programs.
  
  
  METHODS
  All urban AI/AN patients (n = 710) and random sample records of rural AI/AN patients (n=1420).
  
  
  METHODS
  Adherence to guidelines for process measures and intermediate outcomes of diabetes care.
  
  
  RESULTS
  Compared to the rural sample, urban patients were more likely to have received diabetes education during the prior year (P < or = .05). Annual dental examinations were less common among urban patients than rural patients (19% vs 41%, P < or = .001). Completion of laboratory testing and immunizations were similar in both groups. Adjusted mean levels for intermediate outcomes of diabetes care and the percentage achieving recommended levels varied slightly but were not statistically or clinically significant.
  
  
  CONCLUSIONS
  Few differences in the quality of diabetes care were found between urban and rural Indian health sites. Differences in the receipt of dental examinations may reflect differences in resources and staffing between urban and rural settings. This study serves as a baseline for the assessment of ongoing interventions aimed at improving the quality of care.
authors.affiliation: IHS Division of Diabetes Treatment and Prevention, Albuquerque, New Mexico, USA. kelly.moore@ihs.gov
authors.forename: Kelly
authors.initials: K
authors.lastname: Moore
authors.forename: Yvette
authors.initials: Y
authors.lastname: Roubideaux
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.forename: Ray
authors.initials: R
authors.lastname: Shields
authors.forename: Kelly
authors.initials: K
authors.lastname: Acton
mesh_terms: D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology* / Q000451:nursing*; D005260:Female; D006268:Health Facilities / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000592:standards*; D019037:Urban Health Services / Q000592:standards*