Physician Process and Patient Outcome Measures for Diabetes ... : Medical Care (original) (raw)

Original Article

Relationships to Organizational Characteristics

Ward, Marcia M. PhD*; Yankey, Jon W. MS†; Vaughn, Thomas E. PhD*; BootsMiller, Bonnie J. PhD†‡; Flach, Stephen D. MD, PhD‡; Welke, Karl F. MD§; Pendergast, Jane F. PhD¶; Perlin, Jonathan MD, PhD, MSHA, FACP∥; Doebbeling, Bradley N. MD, MSc**††‡‡

From the *Department of Health Management and Policy, University of Iowa, Iowa City, Iowa; †Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; ‡Department of Internal Medicine, University of Iowa, Iowa City, Iowa; §Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; ¶Department of Biostatistics, University of Iowa, Iowa City, Iowa; ∥Office of Quality and Performance, Veterans Health Administration, Washington DC;**Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana; ††Regenstrief Institute for Healthcare, Inc, Indianapolis, Indiana, and ‡‡Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Supported by the Department of Veterans Affairs, the Veterans Health Administration, Health Services Research and Development Service Quality Enhancement Research Initiative (QUERI) Grants, #CPI99-126 and CPI01-141, of which Dr. Doebbeling is Principal Investigator, Staff Physician, and Director of HSRD at the Roudebush VAMC in Indianapolis, Indiana.

Reprints: Marcia M. Ward, PhD, Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA 52242-1008. E-mail: [email protected].

Abstract

Background:

Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes.

Purpose:

To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes.

Design:

Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers.

Sample:

We sampled 109 Veterans Affairs medical centers (VAMCs).

Results:

Analyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients.

Conclusions:

Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.