The objective of this study was to compare self-reported measures of diabetes care with measures derived from medical records in a well-defined population. Diabetes measures were collected through a 1997 Behavioral Risk Factor Surveillance System telephone survey of American Indians living on or near 7 Montana reservations (N = 398) and were compared with data collected from charts of a systematic sample of American Indians with diabetes seen in 1997 at Indian Health Service (IHS) facilities. Survey respondents were more likely to report a duration of diabetes > or = 10 years (44 vs 31%), annual dilated retinal exam (75 vs 59%), and an influenza immunization in the past year (73 vs 57%) compared with estimates from the chart audit. Estimates of pneumococcal immunization (88 vs 42%), annual cholesterol screening (86 vs 69%), and overweight, based on body mass index (67 vs 50%), were significantly higher from the chart audit. No significant differences were found between the survey respondents and the chart audit data for annual foot exams (65 vs 61%), annual blood pressure checks (98 vs 93%), high cholesterol (35 vs 41%), and high blood pressure (54 vs 64%). These findings suggest that self-reported data may over and underestimate specific measures of diabetes care.
Mentoring and technical support is an effective method to increase personnel skills for DSME and to increase access to quality education programs in rural areas.
The use of health information technology (HIT) and health information management (HIM) to provide accurate and timely data to health care providers in poor rural and underserved areas is often seen as a means of optimizing quality of care, reducing medical errors, and reducing cost. 1−11 Research shows that HIT can be an expensive investment that yields minimal benefits if not carefully implemented and, as a result, those groups identified as priority populations may receive substandard care. 2,12−16 Health systems in rural areas have used HIM, HIT, and telehealth in multicomponent efforts to improve quality of care, access, and efficiency. Results include higher productivity and patient satisfaction rates, shorter hospital stays, lower readmission rates, trimmed medical costs, and improved control of chronic conditions. 6,17,18 These findings indicate that telehealth, HIM, and HIT can contribute to improvements in quality and population health in rural settings by monitoring patients, identifying high-risk patients, measuring clinical performance overall and for specific patient groups, and providing clinical decision support. 19 Telehealth, HIM, and HIT applications can also improve access to timely, high-quality care.
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