Please use this identifier to cite or link to this item: https://doi.org/10.1161/JAHA.117.005999
Title: Quality of care of the initial patient cohort of the diabetes collaborative registry®
Authors: Arnold, S.V
Goyal, A
Inzucchi, S.E
McGuire, D.K
Tang, F
Mehta, S.N
Sperling, L.S
Maddox, T.M
Einhorn, D
Wong, N.D
Hammar, N
Fenici, P
Khunti, K
Lam, C.S.P 
Kosiborod, M
Keywords: angiotensin receptor antagonist
dipeptidyl carboxypeptidase inhibitor
antidiabetic agent
antihypertensive agent
adult
aged
Article
blood pressure regulation
cohort analysis
coronary artery disease
counseling
diabetes mellitus
eye examination
female
foot care
glycemic control
health care quality
human
kidney disease
major clinical study
male
patient care
priority journal
register
screening
smoking cessation
tobacco
blood
blood pressure
clinical practice
clinical trial
diabetes mellitus
diabetic complication
drug effect
glucose blood level
health care disparity
health care quality
hypertension
metabolism
middle aged
multicenter study
pathophysiology
primary health care
standards
total quality management
treatment outcome
United States
Aged
Antihypertensive Agents
Blood Glucose
Blood Pressure
Diabetes Complications
Diabetes Mellitus
Female
Healthcare Disparities
Humans
Hypertension
Hypoglycemic Agents
Male
Middle Aged
Practice Patterns, Physicians'
Primary Health Care
Quality Improvement
Quality Indicators, Health Care
Registries
Treatment Outcome
United States
Issue Date: 2017
Citation: Arnold, S.V, Goyal, A, Inzucchi, S.E, McGuire, D.K, Tang, F, Mehta, S.N, Sperling, L.S, Maddox, T.M, Einhorn, D, Wong, N.D, Hammar, N, Fenici, P, Khunti, K, Lam, C.S.P, Kosiborod, M (2017). Quality of care of the initial patient cohort of the diabetes collaborative registry®. Journal of the American Heart Association 6 (8) : e005999. ScholarBank@NUS Repository. https://doi.org/10.1161/JAHA.117.005999
Abstract: Background-Although guidelines and performance measures exist for patients with diabetes mellitus, achievement of these metrics is not well known. The Diabetes Collaborative Registry® (DCR) was formed to understand the quality of diabetes mellitus care across the primary and specialty care continuum in the United States. Methods and Results-We assessed the frequency of achievement of 7 diabetes mellitus-related quality metrics and variability across the Diabetes Collaborative Registry® sites. Among 574 972 patients with diabetes mellitus from 259 US practices, median (interquartile range) achievement of the quality metrics across the practices was the following: (1) glycemic control: 19% (5-47); (2) blood pressure control: 80% (67-88); (3) angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in patients with coronary artery disease: 62% (51-69); (4) nephropathy screening: 62% (53-71); (5) eye examination: 0.7% (0.0-79); (6) foot examination: 0.0% (0.0-2.3); and (7) tobacco screening/cessation counseling: 86% (80-94). In hierarchical, modified Poisson regression models, there was substantial variability in meeting these metrics across sites, particularly with documentation of glycemic control and eye and foot examinations. There was also notable variation across specialties, with endocrinology practices performing better on glycemic control and diabetes mellitus foot examinations and cardiology practices succeeding more in blood pressure control and use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Conclusions-The Diabetes Collaborative Registry® was established to document and improve the quality of outpatient diabetes mellitus care. While target achievement of some metrics of cardiovascular risk modification was high, achievement of others was suboptimal and highly variable. This may be attributable to fragmentation of care, lack of ownership among various specialists concerning certain domains of care, incomplete documentation, true gaps in care, or a combination of these factors. © 2017 The Authors and Medtronic.
Source Title: Journal of the American Heart Association
URI: https://scholarbank.nus.edu.sg/handle/10635/175203
ISSN: 20479980
DOI: 10.1161/JAHA.117.005999
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