Assessing Diabetes Care Disparities with Ambulatory Care Quality Measures

Abstract

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.

Associations Between Community Sociodemographics and Performance in HEDIS Quality Measures: A Study of 22 Medical Centers in a Primary Care Network

“…The main finding of this set of analyses is a strong and significant correlation between neighborhood SDS factors and HEDIS performance measures, particularly those measures presumed to reflect outcomes of care. This is consistent with findings of previous studies examining similar relationships within a single health system 25 and across 160 physician organizations. 22 The present study was able to control for important confounding factors because of the structure and process comparability of the study sites.…”

“…Many of these relationships have been observed by others, 17,18,22,25 but interpretation in terms of implications for quality of care measurement has typically been challenging because it has been difficult to separate effects of actual quality of care delivered from confounding effects at both the individual patient and community levels. Statistical methods exist for trying to separate the 2 sets of contributing factors (process quality and non–health care factors) 18,19,20 but there still can be difficulty in sorting out whether observed differences are related to “where you go” versus “who you are” or “where you live.” 26…”

Impact Of Risk Adjustment For Socioeconomic Status On Medicare Advantage Plan Quality Rankings

“…We chose these dichotomous variables because they have been included as quality measures in the calculation of star ratings and are significantly affected by sociodemographic factors. 15,16 Also, intermediate outcome measures such as these are more consistently affected by social risk factors than are process measures. 15 …”

Racial and Social Impacts of Diabetes Mellitus: An Autobiographical Case Report

“…Despite health professionals' training in compassionate and empathetic care as well as quality improvements in health systems for managing diabetes, racial and ethnic disparities continue to persist. Hispanic/Latinx, Black/African American, Asian, and Native American/Alaskan Native patients are less likely to participate in diabetes care management, whether self-directed or performed by a clinician with some Asian identities having worse diabetes management compared to other minoritized populations [10,11]. Reasons for poor management include both clinician and patient influences.…”