Quality of Care of the Initial Patient Cohort of the Diabetes Collaborative Registry ^®

Abstract

BackgroundAlthough 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 ResultsWe 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.ConclusionsThe 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.

Cardiovascular risk factor control in British adults with diabetes mellitus: Retrospective cohort study

“…The suboptimal control of cardiovascular risk factors in patients with type 2 diabetes we found in UK primary care practices is actually better than those reported in the United States and European studies . For example, a recent publication from the Swedish National Diabetes Register reported that only 5% of adults with type 2 diabetes were nonsmokers, did not have albuminuria, had BP < 140/80 mm Hg, LDL cholesterol <2.5 mmol/L and HbA1C < 7.0 .…”

National diabetes registries: do they make a difference?

“…The main purpose of many diabetes registries is to support improvement in the quality of care and adherence to national and international treatment guidelines. Reports or studies from Sweden, Denmark, Norway, Germany, Scotland, England, and the USA have shown to effectuate this [15,16,18,23,28,29,[31][32][33][34][35]. Treatment targets from national guidelines were achieved in a great part of the diabetic population [26,28,36].…”

“…Almost all national registries were able to identify unmet treatment targets for HbA1c, blood pressure, or lipid levels [16,17,28,31,[36][37][38][39][40][41][42]. Data from the Norwegian diabetes registry showed that 10% of adult patients with type 1 diabetes treated in specialist clinics reached treatment goals for HbA1c, LDL cholesterol, and blood pressure [31]. Another purpose of diabetes registries conducting epidemiological research to give insight in incidence, prevalence, or complications.…”

“…Finally, data from national registries may also be used in healthcare policy making, for example, to identify therapies and treatment models that deliver for people with diabetes. Sweden, Norway, Germany, Scotland, England, and Saudi Arabia have published reports or articles containing treatment suggestions based on findings from their registry data [31,[50][51][52][53][54].…”

A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and Longevity in Mental Illness

“…Effective interventions to address cardiovascular disease and its risk factors and behaviors in people with SMI exist, but there are significant implementation gaps. 31,32 While such gaps also exist in the general population, [33][34][35][36][37] they are exacerbated among the population with SMI. Those with SMI-particularly the nearly 70% of people with SMI covered by Medicaid in the U.S. 38 -often receive sub-optimal cardiovascular care.…”