Variation in Office-Based Quality: A Claims-Based Profile of Care Provided to Medicare Patients With Diabetes

Jonathan Weiner, Stephen T. Parente, Deborah W. Garnick, Jinnet Fowles, Ann G. Lawthers, R. Heather Palmer

Research output: Contribution to journalArticle

Abstract

To demonstrate that claims data “profiling" can be used as an on-going method to support ambulatory care quality improvement; to measure the quality of office-based care provided to elderly patients with diabetes in three states; and to identify factors associated with better attainment of quality standards. —A cross-sectional study based on a 100% sample of the Medicare claims(Part B and Part A) submitted between July 1, 1990, and June 30,1991. —All primary care practices(both solo and group) actively seeing Medicare patients with diabetes in Alabama, Iowa, and Maryland(n=2980). —All elderly(≥65 years) Medicare patients seen by the study physicians and assigned a diagnosis of diabetes(n=97 388) by any office-based physician during the year. —The proportion of patients with diabetes receiving the following procedures(from any provider) at least once during the study period: hemoglobin A 1C measurement, ophthalmologic examination, total cholesterol measurement, and blood glucose measurement. We considered the first three services to be optimally recommended and blood glucose measurement to be of limited use. —Based on analyses of services provided in the ambulatory setting, we found that 84% of diabetics did not appear to receive the recommended hemoglobin A1C measurement, 54% did not see an ophthalmologist, and 45% received no cholesterol screening. Practice patterns varied considerably across the three states(up to 2.38-fold), even after adjusting for patient case mix and physician characteristics. Patients of general practitioners were less likely to meet recommended quality criteria than patients of internists or family practitioners. Patients receiving care from rural practitioners were less likely to receive services, either recommended or not, than those in urban locations. —Elderly patients with diabetes do not appear to be receiving optimal care. This study underscores the value of practice guideline development and dissemination in the ambulatory arena. This study provides substantial evidence that existing administrative claims data can be used to support ambulatory quality improvement activities.(JAMA1995;273:1503-1508).

Original languageEnglish (US)
Pages (from-to)1503-1508
Number of pages6
JournalJournal of the American Medical Association
Volume273
Issue number19
DOIs
StatePublished - May 17 1995

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Medicare
Quality Improvement
Blood Glucose
Medicare Part B
Cholesterol
Physicians
Hemoglobin A
Physicians' Offices
Diagnosis-Related Groups
Private Practice
Ambulatory Care
Practice Guidelines
General Practitioners
Primary Health Care
Patient Care
Hemoglobins
Cross-Sectional Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Variation in Office-Based Quality : A Claims-Based Profile of Care Provided to Medicare Patients With Diabetes. / Weiner, Jonathan; Parente, Stephen T.; Garnick, Deborah W.; Fowles, Jinnet; Lawthers, Ann G.; Palmer, R. Heather.

In: Journal of the American Medical Association, Vol. 273, No. 19, 17.05.1995, p. 1503-1508.

Research output: Contribution to journalArticle

Weiner, Jonathan ; Parente, Stephen T. ; Garnick, Deborah W. ; Fowles, Jinnet ; Lawthers, Ann G. ; Palmer, R. Heather. / Variation in Office-Based Quality : A Claims-Based Profile of Care Provided to Medicare Patients With Diabetes. In: Journal of the American Medical Association. 1995 ; Vol. 273, No. 19. pp. 1503-1508.
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