Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary).

Tabák, Ádám G.; Tamás, Gyula; Zgibor, Janice C.; Wilson, Robert; Becker, Dorothy J.; Kerenyi, Z; Orchard, Trevor J.

doi:10.2337/diacare.23.9.1284

Cited by 40 publications

(33 citation statements)

References 22 publications

(26 reference statements)

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“…The U.S. has come under particular scrutiny because of their relatively poor outcomes (which are captured by our index), and available evidence suggests that organizational and social factors may be more prominent than clinical ones (25,26). It is also important to note that disadvantaged population subgroups may contribute to higher mortality (27), and in the U.S. complications and mortality from diabetes are known to be worst among the population of African descent (28,29).…”

Section: Results -mentioning

confidence: 99%

Diabetes as a Tracer Condition in International Benchmarking of Health Systems

2006

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OBJECTIVE -To assess the performance of health systems using diabetes as a tracer condition.RESEARCH DESIGN AND METHODS -We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0 -14 years were extracted from the World Health Organization DiaMond study for the period 1990 -1994; data on death from diabetes for ages 0 -39 years were obtained from the World Health Organization mortality database and converted into agestandardized death rates for the period 1994 -1998, using the European standard population.RESULTS -The M/I ratio varied Ͼ10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada.CONCLUSIONS -The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them. Diabetes Care 29:1007-1011, 2006D esigning simple, practical, and understandable ways to assess health system performance remains a challenging aspiration. Recognizing the multifunctional complexity of a health system, existing frameworks use a range of indicators to capture the different aspects of health systems (1). However, many of these indicators have no obvious direct link to health outcomes, and the policy implications are often unclear (2). A complementary approach involves the use of tracer conditions (3), which is based on the premise that focusing on carefully selected health problems makes it possible to identify weaknesses in elements of the health system and to obtain more direct insight into its performance.The rising burden of chronic diseases worldwide demands measures that will capture differences in the care provided to those affected, and we propose diabetes as a suitable tracer condition; it is well defined, fairly easy to diagnose (4), and common. The prevalence worldwide is estimated to be 2.8% (2000) and expected to increase to 4.4% by 2030 (5), with this figure already exceeded in the U.S. (6). While mainly type 2 diabetes is increasing, type 1 diabetes is also increasing swiftly, at ϳ3% per year, especially in Central and Eastern Europe and among young children (7).Health system performance affects diabetes outcomes in several ways. Effective treatment reduces the risk of disabling or fatal complications (8 -10). This is most apparent for type 1 diabetes in developing countries where access to insulin is extremely limited (11). However, it is also seen where h...

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Section: Results -mentioning

confidence: 99%

Diabetes as a Tracer Condition in International Benchmarking of Health Systems

2006

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“…This study, however, did not follow the same cohort for the two time periods. In a cross-sectional comparison, Tabak et al (25) found lower rates of proliferative retinopathy, albuminuria, and end-stage renal disease when comparing the DiabCare Hungary, where diabetes care is specialized, with the EDC population, where care is a mixture of specialist and generalist providers. In the Verona Diabetes Study (26), individuals attending the diabetes center experienced a 17% lower mortality rate than individuals seeing family practitioners.…”

Section: Incidence Of Complicationsmentioning

confidence: 99%

Influence of Health Care Providers on the Development of Diabetes Complications

et al. 2002

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OBJECTIVE -To quantify total diabetes care received (generalist or specialist) from diagnosis onward and its association with the incidence of diabetes complications in a representative cohort of patients with type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 429 subjects from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective follow-up study of childhoodonset type 1 diabetic subjects first seen between 1986 and 1988 (mean age 28 years, mean duration 19 years), followed biennially for up to 10 years were studied. Specialist care was defined as care received from a board-certified endocrinologist, diabetologist, or diabetes clinic and quantified as the percent of diabetes duration spent in specialist care.RESULTS -There was a significant trend for a higher incidence of neuropathy, overt nephropathy, and coronary artery disease with lower use of specialist care. Multivariate analyses controlling for diabetes duration, demographic characteristics, health care practices, and physiological risk factors demonstrated that higher past use of specialist care was found to be significantly protective against the development of overt nephropathy (risk ratio 0.43, 95% CI 0.21-0.88) and neuropathy (0.54, 0.35-0.83) and weakly protective against coronary artery disease (0.65, 0.37-1.1).CONCLUSIONS -A higher proportion of diabetes duration spent in specialist care may result in delayed development of certain diabetes complications independent of other risk factors. This study thus supports the concept that the benefits of specialist care should be available to all patients with type 1 diabetes.

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“…Patients randomized to intensive therapy in the SDIS initially received faceto-face and telephone contact every second week (2). This level of care, and the outcomes that resulted from it in randomized trials (in terms of glycemic control and microvascular complications), have been difficult to implement in clinical practice (3,4) despite strong evidence of its favorable impact on average cost and life expectancy (5,6).…”

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confidence: 99%

Telecare for Patients With Type 1 Diabetes and Inadequate Glycemic Control

et al. 2004

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OBJECTIVE -To determine the efficacy of telecare (modem transmission of glucometer data and clinician feedback) to support intensive insulin therapy in patients with type 1 diabetes and inadequate glycemic control.RESEARCH DESIGN AND METHODS -Thirty-one patients with type 1 diabetes on intensive insulin therapy and with HbA 1c Ͼ7.8% were randomized to telecare (glucometer transmission with feedback) or control (glucometer transmission without feedback) for 6 months. The primary end point was 6-month HbA 1c . To place our findings in context, we pooled HbA 1c change from baseline reported in randomized trials of telecare identified in a systematic review of the literature.RESULTS -Compared with the control group, telecare patients had a significantly lower 6-month HbA 1c (8.2 vs. 7.8%, P ϭ 0.03, after accounting for HbA 1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA 1c Յ7% (29 vs. 7%; risk difference 21.9%, 95% CI Ϫ4.7 to 50.5). Nurses spent 50 more min/patient giving feedback on the phone with telecare patients than with control patients. Meta-analysis of seven randomized trials of adult patients with type 1 diabetes found a 0.4% difference (95% CI 0 -0.8) in HbA 1c mean change from baseline between the telecare and control groups.CONCLUSIONS -Telecare is associated with small effects on glycemic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.

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Targets and reality: a comparison of health care indicators in the U.S. (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary).

Cited by 40 publications

References 22 publications

Diabetes as a Tracer Condition in International Benchmarking of Health Systems

Diabetes as a Tracer Condition in International Benchmarking of Health Systems

Influence of Health Care Providers on the Development of Diabetes Complications

Telecare for Patients With Type 1 Diabetes and Inadequate Glycemic Control

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