title: Diabetes care in a predominantly Native Hawaiian and Pacific Islander outpatient population.
abstract: OBJECTIVE
  Racial differences in diabetes care and outcomes, particularly among African Americans and Hispanics, have been well-recognized. The goal of this study was to evaluate the quality of diabetes care, using nationally recognized standards of care, in a multispecialty, hospital-based clinic that cares for a predominantly Native Hawaiian and Pacific Islander population.
  
  
  METHODS
  We identified patients with a new primary or secondary diagnosis of diabetes during a visit (baseline visit) between January 2005 and June 2006 at the Queen Emma Clinics. Each patient's medical record was reviewed to obtain demographic and clinical information related to diabetes, including laboratory and test results and medications, from the baseline visit through 12 months follow-up. Performance indicators were selected from those recommended by the National Diabetes Quality Improvement Alliance and included selected 8 measures: 1) Hemoglobin A1c ≥9.0%; 2) Annual lipid panel checked; 3) Systolic blood pressure <140 mmHg; 4) LDL cholesterol <130 mg/dL) 5) Annual fundoscopic examination; 6) Foot examination; 7) Aspirin use; 8) Annual evaluation for urine protein.
  
  
  RESULTS
  We identified 364 patients, the majority Pacific Islanders (58%), with Asians (15%) and Native Hawaiians (17%) more frequent than Caucasians (10%). Compared with Caucasians, Native Hawaiians and Pacific Islanders were significantly more likely to have poor glucose control. There were no significant differences between groups for the other measures. Patients compared favorably when compared with national benchmarks. For 2 indicators, adherence was significantly higher for the total study population compared with the US average (systolic blood pressure <140 mmHg, aspirin therapy). For 2 indicators, there were no significant difference (LDL cholesterol <130 mg/dL, annual foot exam) and for 2 indicators, adherence was significantly lower for the study population (hemoglobin A1c >9%, annual fundoscopic examination).
  
  
  CONCLUSIONS
  Native Hawaiians and Pacific Islanders with diabetes have poorer blood glucose control compared with Caucasians and Asians, but the overall care is otherwise generally similar. The diabetes care received by patients in this clinic that treats a generally underserved population compares favorably with national benchmarks.
authors.affiliation: Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lee
authors.forename: Janet
authors.initials: J
authors.lastname: Onopa
authors.forename: Marjorie K
authors.initials: MK
authors.lastname: Mau
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006254:Hawaii; D054625:Healthcare Disparities; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010045:Outpatients / Q000706:statistics & numerical data; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids