Glycemic and lipid control among patients with diabetes at six U.S. public hospitals.
OBJECTIVE
Public hospital systems share a mission to provide access to healthcare regardless of ability to pay. While public hospital systems care for large numbers of socioeconomically vulnerable and ethnically diverse populations who have diabetes, little is known about the quality of diabetes care provided in these sites.


METHODS
We assessed the measurement and control of hemoglobin A1c (HbA1c) and lipids (LDL) in a sample of patients with diabetes with > or =2 outpatient visits per year in two consecutive years at one of 6 public hospitals (N=14,222).


RESULTS
High proportions of patients had at least one HbA1c and LDL measurement within 2 years (89% and 88%, respectively). Thirty-five percent had HbA1c < 7.0%; 21% had HbA1c > or =9.5%; 36% had LDL<100 mg/dl; 10% had LDL>160 mg/dl. Non-White patients and patients who were never insured were most at risk for poor glycemic and lipid control.


CONCLUSIONS
The quality of care, as measured by glycemic and lipid monitoring and control among ongoing users of public hospital systems, was similar to that of other health systems, but disparities exist across race/ethnicity and insurance status. Because of the critical role these institutions play in providing care to the underserved, research is needed to explore factors contributing to differences in glycemic and lipid control and develop strategies to improve chronic disease management in these systems.
Chew
Lisa D
LD
Department of Medicine, Division of General Internal Medicine, University of Washington Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA. lchew@u.washington.edu
Schillinger
Dean
D
Maynard
Charles
C
Lessler
Daniel S
DS
D000293:Adolescent; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood* / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives* / Q000032:analysis; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
D006442:Glycated Hemoglobin; D008055:Lipids; C025617:glucosylated hemoglobin A