Ethnicity, language, specialty care, and quality of diabetes care.
OBJECTIVE
To investigate ethnicity, language, specialty care, and quality of diabetes care in one medical center.


METHODS
Retrospective review of computerized records of patients with diabetes age > or = 50 years who were regularly cared for in general medicine, family practice, or diabetes clinics from 1997 to 2000. Measures of processes of care were tests for creatinine, cholesterol, hemoglobin A1C (HbA1C), and microalbumin; ophthalmologic care; and total visits. Intermediate outcomes were average systolic blood pressure (SBP) < 140 mm Hg and HbA1C < 8%.


RESULTS
Among 1323 patients, test rates for creatinine, cholesterol, microalbuminuria, and HbA1C were 76.6%, 54.7%, 17.2%, 78.8%, respectively. Only 31.0% had ophthalmology visits, 57.4% had SBP < 140 mm Hg, and 62.0% had HbA1C < 8%. In multivariate analyses, African Americans, Asians, and Latinos received more tests and had more total visits than Whites. Intermediate outcomes were similar except that Asians were more likely (odds ratio [OR] = 1.78, 95% confidence interval [CI] 1.26-2.50) to have SBP < 140 mm Hg. Limited English proficient patients had more total visits (7.0) than English speakers (6.5) (P = .01). Compared to patients with only primary care, patients with a diabetes specialist had more microalbuminuria (OR 3.04, 95% CI 1.87-4.95) and HbA1C (OR 1.91, 1.12-3.26) tests, while those with both types of care were more likely to have each of the five process measures but less likely to have HbA1C < 8%.


CONCLUSIONS
Quality of diabetes care was suboptimal for most patients. No ethnic disparity was seen in intermediate outcomes, which may have been achieved through more tests and visits. Combined care by primary and diabetes clinicians may be optimal.
Nguyen
Tung T
TT
Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California, USA.
Daniels
Nicholas A
NA
Gildengorin
Ginny L
GL
Pérez-Stable
Eliseo J
EJ
D000368:Aged; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012495:San Francisco