Measuring the quality of diabetes care in urban and rural Indian health programs.
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.
Moore
Kelly
K
IHS Division of Diabetes Treatment and Prevention, Albuquerque, New Mexico, USA. kelly.moore@ihs.gov
Roubideaux
Yvette
Y
Noonan
Carolyn
C
Goldberg
Jack
J
Shields
Ray
R
Acton
Kelly
K
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*