Assessing Diabetes Care Disparities with Ambulatory Care Quality Measures.

OBJECTIVE: To identify and describe racial/ethnic disparities in overall diabetes management. DATA SOURCE/STUDY SETTING: Electronic health record data from calendar year 2010 were obtained from all primary care clinics at one large health system in Minnesota (n = 22,633). STUDY DESIGN: We used multivariate logistic regression to estimate the odds of achieving the following diabetes management goals: A1C <8 percent, LDL cholesterol <100 mg/dl, blood pressure <140/90 mmHg, tobacco-free, and daily aspirin. PRINCIPAL FINDINGS: Blacks and American Indians have higher odds of not achieving all goals compared to whites. Disparities in specific goals were also found. CONCLUSIONS: Although this health system has above-average diabetes care quality, significant disparities by race/ethnicity were identified. This underscores the importance of stratifying quality measures to improve care and outcomes for all.

Coaching of physicians by RNs to improve diabetes care.

PURPOSE: The purpose of this study is to describe preliminary results of an innovative quality improvement intervention focused on improving physician practice patterns in diabetes care via Coaching Physicians by RN certified diabetes educators (CDEs), a program called "CPR for Diabetes Care." METHODS The program identified primary care physicians with optimal diabetes control rates below the system aggregate (n = 195). Physicians with the lowest rates (n = 74) were targeted for comprehensive intervention. All other low-performing physicians practicing in the same clinic system (n = 121) comprised the comparison group. Data were obtained from electronic diabetes registries for 2007 and 2008. Each physician had a set of measures from 2 points in time. Measures included optimal diabetes scores and the 5 component measures of the optimal diabetes care bundle (A1C <7, low-density lipoprotein cholesterol <100, blood pressure <130/80, aspirin use if older than 40, and no tobacco use). T tests and difference-in-difference models were used to examine changes over time. RESULTS: Optimal diabetes scores increased 11.7 points (from 14.7% to 26.4%) for intervention physicians and 4.0 points (from 29.7% to 32.9%) for comparison physicians. The improvement was greater for the intervention group. The greatest component improvements were in control of blood pressure and cholesterol. CONCLUSIONS Coaching low-performing physicians dramatically improved the proportion of diabetes patients with optimal diabetes control. The CPR for Diabetes Care program represents an innovative and effective way to address the long-standing problem of disseminating and sustaining quality improvement efforts by focusing on low-performing physicians.