Results: Purpose : Here we describe our experience using a comprehensive diabetes quality of care measure, and report trends in diabetes quality of care since the measure was adopted community-wide 4 years ago.
Methods: Seven Minnesota health plans initiated Minnesota Community Measurement in 2002. The program measures and publicly reports care across multiple clinical domains in fifty plus primary care and multi-specialty group practices. To assess quality of diabetes care, the project sampled 60 diabetes patients per medical group and classified each as meeting or not meeting all the following measures: glycated hemoglobin (A1c) <= 8%, LDL-cholesterol (LDL) <=130 mg/dl, documented non-smoking status (NSMK), and regular aspirin (ASA) use. Statistical comparisons across time and across groups were done using the Chi-square statistic and nested multivariate logistic regression models.
Results : The proportion of diabetes patients who met all 5 quality components was 7.6% in 2001, 11.7% in 2002, 12.0% in 2003, 15.5% in 2004, and 19.9% in 2005. In 2001 the range across provider groups was 0% to 20%, and in 2004 the range across provider groups was 1% to 40%. In 2001 6% of provider groups had over 15% of patient meeting this measure, and in 2004, 46% of provider groups had over 15% of patients at this goal (?2=20.8, p<.0001). In 2005, among the 5 measures, the one with the lowest proportion of patients at goal was BP (47.7%), followed by A1c (65.7%), ASA (66.6%), LDL (66.8%), and NSMK (70.1%).
Discussion : These data show substantial improvement in diabetes care in a short period of time, motivated in part by a commonly agreed upon publicly reported comprehensive diabetes control measure. Further substantial improvement in community levels of diabetes care are possible, and special attention to BP control may be indicated.