Relation between the level of American Indian and Alaska Native diabetes education program services and quality-of-care indicators.
OBJECTIVE
We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care.


METHODS
In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care.


RESULTS
Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05).


CONCLUSIONS
System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs.
Roubideaux
Yvette
Y
Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85716, USA. yvetter@u.arizona.edu
Noonan
Carolyn
C
Goldberg
Jack H
JH
Valdez
S Lorraine
SL
Brown
Tammy L
TL
Manson
Spero M
SM
Acton
Kelly
K
D000328:Adult; D000368:Aged; D000413:Alaska; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007198:Indians, North American / Q000193:education*; D004930:Inuit / Q000193:education*; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D011635:Public Health Administration / Q000592:standards*; D019984:Quality Indicators, Health Care; D012423:Rural Health; D014481:United States; D016549:United States Indian Health Service; D014504:Urban Health
D006442:Glycated Hemoglobin; D008055:Lipids