title: Patient characteristics associated with measurement of routine diabetes care: an observational study.
abstract: BACKGROUND
  Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear. The aim of this study was to assess the strength of associations between patient factors and diabetes care processes and outcomes.
  
  
  METHODS
  We performed an observational study based on routinely collected data of 12,498 diabetes patients in 59 Dutch primary care practices. Data were collected on patient age, gender, whether the patient lived in a deprived area, body mass index and the co-occurrence of cardiovascular disease, chronic obstructive pulmonary disease, depression or anxiety. Outcomes included 6 dichotomous measures (3 process and 3 outcome related) regarding glycosylated hemoglobin, systolic blood pressure and low density lipoprotein-cholesterol. We performed separate hierarchical logistic mixed model regression models for each of the outcome measures.
  
  
  RESULTS
  Each of the process measure models showed moderate effect sizes, with pooled areas under the curve that varied between 0.66 and 0.76. The frequency of diabetes related consultations as a measure of patient compliance to treatment showed the strongest association with all process measures (odds ratios between 5.6 and 14.5). The effect sizes of the outcome measure models were considerably smaller than the process measure models, with pooled areas under the curve varying from 0.57 to 0.61.
  
  
  CONCLUSIONS
  Several non-modifiable patient factors could be associated with processes and outcomes of diabetes care. However, associations were small. These results suggest that case-mix correction or stratification in assessing diabetes care has limited practical relevance.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Arna L
authors.initials: AL
authors.lastname: Van Doorn-Klomberg
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Atsma
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Birgit
authors.initials: B
authors.lastname: Jansen
authors.affiliation: Dutch College of General Practitioners (NHG), Utrecht, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: René J
authors.initials: RJ
authors.lastname: Wolters
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care; D020379:Risk Adjustment
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