TY - JOUR
T1 - Variation in Office-Based Quality
T2 - A Claims-Based Profile of Care Provided to Medicare Patients With Diabetes
AU - Weiner, Jonathan P.
AU - Parente, Stephen T.
AU - Garnick, Deborah W.
AU - Fowles, Jinnet
AU - Lawthers, Ann G.
AU - Palmer, R. Heather
PY - 1995/5/17
Y1 - 1995/5/17
N2 - 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).
AB - 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).
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U2 - 10.1001/jama.1995.03520430039036
DO - 10.1001/jama.1995.03520430039036
M3 - Article
C2 - 7739076
AN - SCOPUS:0029013954
SN - 0098-7484
VL - 273
SP - 1503
EP - 1508
JO - JAMA: The Journal of the American Medical Association
JF - JAMA: The Journal of the American Medical Association
IS - 19
ER -