VA takes long view of
quality diabetes care
Newswise — A new study offers doctors another barometer to
gauge the quality of care they give patients with diabetes.
The study researchers are proposing an evaluation of
diabetes care that tracks providers’ success over time
instead of at a single moment.
“It’s kind of like a movie
versus a snapshot,” said researcher Monika Safford, M.D.
“Most of the ways we measure quality of care are looking at
The study of 125 Veterans
Health Administration facilities nationwide analyzed results
of the blood glucose test A1c, the gold standard for
monitoring how well patients have managed their diabetes in
recent weeks and months.
America’s health care
systems already receive a report card on the quality of
their diabetes care — an assessment largely based on A1c
testing. Health plans are evaluated on the percentage of
diabetes patients who receive the A1c test each year and the
proportion of patients whose diabetes is out of control,
based on an A1c score higher than 9 percent.
The A1c test detects a
hemoglobin protein in the blood that is bound with glucose.
As A1c levels rise, the risks for diabetes complications
also increase and can result in damage to the cardiovascular
system, eyes, kidneys or other organs.
The Veterans Health study,
published in the December Health Services Research journal,
tracked changes in average monthly A1c levels for each
facility during two years. The majority of the facilities
lowered their average-patient A1c levels during the study
“It’s a demonstration
across a population that you can get A1c levels under better
control,” Safford said.
Even a modest drop across
a patient population can translate into fewer of the medical
problems commonly associated with diabetes and elevated A1c
levels, she said.
To highlight differences,
the researchers ranked each facility from worst to best
based on average change in A1c levels. That kind of ranking
could be used to identify the facilities that are the
poorest performers and to determine those that need to
improve the quality of their diabetes care, the study
Knowing how well a health
plan is treating diabetes is valuable consumer information
for anyone shopping for the best care, said Nathaniel Clark,
M.D., national vice president of clinical affairs for the
American Diabetes Association.
Because A1c levels are
influenced by so many factors beyond quality of care — such
as marital status, age or ethnicity — Safford said it is
premature and unfair to link the rankings to accountability.
But she said, “It’s a nice tool for health systems and
physicians to monitor their performance against their
The study received grant
support from the VA Health Services Research and Development
Thompson W, et al.
Assessing quality of diabetes care by measuring longitudinal
changes in hemoglobin A1c in the Veterans Health
Administration. Health Services Research 40(6), 2005