Diabetes Prevalence and Hospital and Pharmacy Use in the Veterans Health Administration (1994): Use of an ambulatory care pharmacy-derived database

Pogach, Leonard; Hawley, Gerald; Weinstock, Ruth S.; Sawin, Clark T.; Schiebe, Harlan; Cutler, Franklin; Zieve, Franklin J.; Bates, Mary Ann; Repke, Denis

doi:10.2337/diacare.21.3.368

Cited by 51 publications

(36 citation statements)

References 7 publications

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“…Pogach et al (19) reported that, in 1994, 11.8% of patients at 62 VA medical centers had diabetes based on prescriptions for diabetes medication or glucose monitoring strips. Kazis et al (18) found that 16.9% of VA enrollees who were in the sampling frame for the 1999 survey had any diagnostic codes for diabetes in VA patient files over the past 2 years.…”

Section: Developing Methodology For Use Of Medical Administrative Datamentioning

confidence: 99%

“…Fortunately, the VA information system is well developed and includes a rich assortment of patient-level data maintained in national databases (7,20). There have been prior attempts to use these data to estimate diabetes prevalence among VA patients (18,19), but these investigators used simple methods without testing for validity or consistency.…”

mentioning

confidence: 99%

“…This is the largest integrated health care system in the U.S., providing comprehensive services to over 4.5 million veterans through 163 medical centers. VA patients tend to be relatively sick with multiple morbidities, and it is likely that diabetes has a high prevalence in this population (17)(18)(19). Fortunately, the VA information system is well developed and includes a rich assortment of patient-level data maintained in national databases (7,20).…”

mentioning

confidence: 99%

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Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data

2004

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OBJECTIVE -To optimize methods for identifying patients with diabetes based on computerized records and to obtain best estimates of diabetes prevalence in Department of Veterans Affairs (VA) patients.RESEARCH DESIGN AND METHODS -The VA Diabetes Epidemiology Cohort (DEpiC) is a linked national database of all VA patients since 1998 with data from VA medical visits, Medicare claims, pharmacy and laboratory records, and patient surveys. Using DEpiC, we examined concordance of diabetes indicators, including ICD-9-CM codes (250.xx), prescription drug treatment, HbA 1c tests, and patient self-report. We determined the optimal criterion for identifying diabetes and used it in estimating diabetes prevalence in the VA.RESULTS -The best criterion was a prescription for a diabetes medication in the current year and/or 2ϩ diabetes codes from inpatient and/or outpatient visits (VA and Medicare) over a 24-month period. This definition had high sensitivity (93%) and specificity (98%) against patient self-report, and reasonable rates of HbA 1c testing (75%). HbA 1c testing alone added few additional cases, and a single diagnostic code added many patients, but without confirmation (reduced specificity). However, including codes from Medicare was critical. Applying this definition for 1998 -2000, we identified an average of 500,000 VA patients with diabetes per year. We also estimated high and increasing diabetes prevalence rates of 16.7% in FY1998, 18.6% in FY1999, and 19.6% in FY2000 and an incidence estimated to be ϳ2% per year.CONCLUSIONS -Development and evaluation of methodology for analyzing computerized patient data can improve the identification of patients with diabetes. The increasing high prevalence of diabetes in VA patients will present challenges for clinicians and health system management.

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Section: Developing Methodology For Use Of Medical Administrative Datamentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data

2004

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“…Patients were identified using electronic pharmacy and laboratory information for fiscal years 1998 and 1999 from each participating VA facility and a national utilization database (11,12). Patients were eligible if they had two outpatient visits of any kind in fiscal year 1999 and were identified as having diabetes based on the following criteria: within the past 12 months they had 1) at least one prescription for a glucose control medication or monitoring supplies; 2) two or more outpatient visits with a diabetesrelated ICD-9 code; or 3) one hospitalization with a diabetes-related ICD-9 code (250.x, 357.2, 362.0, or 366.41).…”

Section: Study Populationmentioning

confidence: 99%

How Well Do Patients’ Assessments of Their Diabetes Self-Management Correlate With Actual Glycemic Control and Receipt of Recommended Diabetes Services?

et al. 2003

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OBJECTIVE -Although patient diabetes self-management is a key determinant of health outcomes, there is little evidence on whether patients' own assessments of their self-management correlates with glycemic control and key aspects of high-quality diabetes care. We explored these associations in a nationwide sample of Veterans' Affairs (VA) patients with diabetes.RESEARCH DESIGN AND METHODS -We abstracted information on achieved level of glycemic control (HbA 1c ) and diabetes processes of care (receipt of HbA 1c test, eye examination, and nephropathy screen) from medical records of 1,032 diabetic patients who received care from 21 VA facilities and had answered the Diabetes Quality Improvement Program survey in 2000. The survey included sociodemographic measures and a five-item scale assessing the patients' diabetes self-management (medication use, blood glucose monitoring, diet, exercise, and foot care [␣ ϭ 0.68]). Using multivariable regression, we examined the associations of patients' reported self-management with HbA 1c level and receipt of each diabetes process of care. We adjusted for diabetes severity and comorbidities, insulin use, age, ethnicity, income, education, use of VA services, and clustering at the facility level.RESULTS -Higher patient evaluations of their diabetes self-management were significantly associated with lower HbA 1c levels (P Ͻ 0.01) and receipt of diabetes services. Those in the 95th percentile for self-management had a mean HbA 1c level of 7.3 (95% CI 6.4 -8.3), whereas those in the 5th percentile had mean levels of 8.3 (7.4 -9.2). For every 10-point increase in patients' ratings of their diabetes self-management, even after adjusting for number of outpatient visits, the odds of receiving an HbA 1c test in the past year increased by 15% (4 -27%), of receiving an eye examination increased by 16% (7-27%), and of receiving a nephropathy screen increased by 13% (2-26%).CONCLUSIONS -In this sample, patients' assessments of their diabetes self-care using a simple five-question instrument were significantly associated both with actual HbA 1c control and with receiving recommended diabetes services. These findings reinforce the usefulness of patient evaluations of their own self-management for understanding and improving glycemic control. The mechanisms by which those patients who are more actively engaged in their diabetes self-care are also more likely to receive necessary services warrant further study. Diabetes Care 26:738 -743, 2003

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“…40,41 These conditions are common in the veteran population and are increasing in the general population due to the rise in obesity and aging. 2,4,20,28,32 Primary and secondary prevention of all of these conditions is usually approached using pharmacological intervention, dietary modification, behavior modification, and exercise. 2,3,10,20 The typical primary care team described above has experts in the first 3 domains, but the team lacks an expert in the domain of exercise/mobility.…”

Section: Department Of Veterans Affairs Salt Lake City Health Care Symentioning

confidence: 99%

Primary Care Physical Therapy Practice Models

Murphy

Greathouse²,

Matsui³

2005

J Orthop Sports Phys Ther

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Diabetes Prevalence and Hospital and Pharmacy Use in the Veterans Health Administration (1994): Use of an ambulatory care pharmacy-derived database

Cited by 51 publications

References 7 publications

Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data

Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data

How Well Do Patients’ Assessments of Their Diabetes Self-Management Correlate With Actual Glycemic Control and Receipt of Recommended Diabetes Services?

Primary Care Physical Therapy Practice Models

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