Comparison of medicine resident diabetes care between Veterans Affairs and academic health care systems.
BACKGROUND
Although others have reported national disparities in the quality of diabetes care between the Veterans Affairs (VA) and private health care delivery systems, it is not known whether these differences persist among internal medicine resident providers in academic settings.


OBJECTIVE
We compared the quality of diabetes primary care delivered by resident physicians in either a private academic health care system (AHS) or its affiliated VA health care system.


METHODS
Cross-sectional observational study


METHODS
We included patients who: had a diagnosis of diabetes, had >2 primary care visits with the same resident provider during 2005, and were not separately managed by an attending physician or endocrinologist. A total of 640 patients met our criteria and were included in the analysis.


RESULTS
Compared to the VA, patients in the AHS were more likely to be younger, female, have fewer medications, and be treated with insulin, but had less comorbidity. Patients in the VA were more likely to be referred for an annual eye exam (94% vs. 78%), receive lipid screening (88% vs. 74%), receive proteinuria screening (63% vs. 34%), and receive a complete foot exam (85% vs. 32%) in analyses adjusted for patient demographics and comorbidities (p-value <0.001 for all comparisons). In adjusted analyses, there were no significant differences in HbA1(c), blood pressure, or LDL cholesterol control.


CONCLUSIONS
In spite of similar resident providers and practice models, there were substantial differences in the diabetes quality of care delivered in the VA and AHS. Understanding how these factors influence subsequent practice patterns is an important area for study.
Powers
Benjamin J
BJ
Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC, USA. power017@mc.duke.edu
Grambow
Steven C
SC
Crowley
Matthew J
MJ
Edelman
David E
DE
Oddone
Eugene Z
EZ
D000046:Academic Medical Centers / Q000592:standards*; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000592:standards*