Effect of Quality Improvement on Racial Disparities in Diabetes Care

Abstract

Background: Racial disparities in care are well documented; information regarding solutions is limited. We evaluated whether generic quality improvement efforts were associated with changes in racial disparities in diabetes care.Methods: Using insurance claims and electronic medical record data, we identified 5101 whites and 1987 blacks with diabetes mellitus receiving care within a multispecialty group practice from 1997 to 2001. We assessed rates of annual low-density lipoprotein cholesterol level testing, low-density lipoprotein cholesterol level control (Ͻ130 mg/dL [Ͻ3.37 mmol/L]), statin therapy, annual glycosylated hemoglobin level testing, glycosylated hemoglobin level control (Ͻ7.0%), and annual dilated eye examinations. We used logistic regression models with generalized estimating equations to adjust for race, year, race ϫ year interactions, age, and sex.Results: Rates of annual low-density lipoprotein cholesterol level testing increased from 39% to 64%, while the white-black disparity decreased from 14% to 4%; rates of low-density lipoprotein cholesterol level control increased from 15% to 43%, while the white-black disparity decreased from 9% to 6% (PϽ.001 for both race ϫ year interactions). Statin therapy rates increased from 20% to 37%; however, black patients remained less likely than white patients to receive therapy. The 1997 rates of annual glycosylated hemoglobin level testing (76%) and annual eye examinations (74%) were high, and there was no white-black disparity over time. Rates of glycosylated hemoglobin level control remained low (31%), and the white-black disparity remained constant at 10%.Conclusions: Racial disparities were diminished in some aspects of diabetes care following variably successful quality improvement, but differences in the use of statins and glycemic level control persisted. Reducing disparities may require a focus on minority health.

Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes

“…Consistent with findings in studies of the general population with Type 2 diabetes (Safford et al, 2003;Sequist et al, 2006), we found that African-Americans in our sample were less likely than Caucasians to receive cholesterol-lowering statin medications. This is particularly concerning as AfricanAmericans experience higher rates of Type 2 diabetes and its complications (Egede and Dagogo-Jack, 2005).…”

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

“…Previous research [11][12][13][14][15][16] and ACO program requirements 2,32 suggest that provider integration encouraged by ACO programs might be associated with enhanced abilities to monitor and improve quality of care, but we found that larger provider groups achieved smaller racial disparities in only two of six quality measures we analyzed. Finally, to the extent that new payment incentives improve the quality of care provided by ACOs, our findings and previous studies [17][18][19] suggest these potential gains may not be associated with consistently reduced racial disparities in quality. Thus, although quality improvement due to ACO initiatives would benefit a substantial number of black Medicare beneficiaries served by ACOs, such improvement may not be associated with smaller disparities among ACOs or nationally.…”

“…Moreover, prior research suggests that overall improvements in quality have not been consistently associated with reduced disparities, particularly in clinical outcomes. [17][18][19] Thus, while provider integration and quality improvement fostered by ACO programs might improve care for many patients, such gains may or may not be associated with reductions in health disparities.…”

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

“…Lower statin use by blacks and women has been observed in general primary‐care populations,14, 15, 16, 17, 18, 19 but no studies have examined patterns of statin use by race‐sex groups among individuals with diabetes mellitus in the United States. Knowing whether there are race‐sex differences in statin use among adults with diabetes mellitus and understanding the root causes of these disparities are important to design tailored interventions to improve adherence to statin therapy.…”