An instrumental variable analysis of the impact of practice guidelines on improving quality of care and diabetes-related outcomes in the elderly Medicare population.
The effect of the diabetes practice guideline recommending >or=2 HbA1c tests annually on diabetes-related outcomes was evaluated using Medicare claims data. The study population included 1998 and 1999 incident diabetes patients aged >or= 67 years, who were Medicare eligible and without known diabetes-related complications at baseline. Number of HbA1c tests was measured 1 year after diabetes incidence. All-cause death and diabetes complications were identified during follow-up, through December 2003. The analysis was conducted with an instrumental variable method and a bivariate probit model, controlling for individual, social, and health care system characteristics. Among 13 033 patients, 27.1% followed the practice guideline. Receiving >or=2 HbA1c tests annually was significantly associated with a decrease in probability of 28.8 percentage points for macrovascular complications, 28.7 for atherosclerotic heart disease, and 23.1 for chronic kidney disease or end-stage renal disease in the 4-year follow-up period.
United States Renal Data System Coordinating Center, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Suying Li
Jiannong Liu
David
D
Gilbertson
Marshall
M
McBean
Bryan
B
Dowd
Allan
A
Collins
D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States
D006442:Glycated Hemoglobin