SUMMARIES FOR PATIENTS

Quality of Care for Patients with Diabetes

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The summary below is from the full report titled "Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study." It is in the 17 August 2004 issue of Annals of Internal Medicine (volume 141, pages 272-281). The authors are E.A. Kerr, R.B. Gerzoff, S.L. Krein, J.V. Selby, J.D. Piette, J.D. Curb, W.H. Herman, D.G. Marrero, K.M.V. Narayan, M.M. Safford, T. Thompson, and C.M. Mangione.

What is the problem and what is known about it so far?

Diabetes is a disease in which the body cannot properly use and store glucose. It is a life-long condition that requires continuous management. Diabetes can lead to many complications, including heart attacks, strokes, blindness, kidney failure, nerve damage, poor circulation, and loss of limbs. Adults with diabetes often have other conditions, such as high blood pressure or abnormal lipid levels, that also increase risks for complications. Thus, properly managed diabetes often requires several things. These include blood tests; eye and foot checks; medications to control glucose levels, lipid levels, and blood pressure; and counseling about diet, weight, exercise, and aspirin use to help prevent heart attacks. Few studies compare how well different health care systems deliver these components of diabetes care.

Why did the researchers do this particular study?

To compare quality of care for diabetes between patients seen in the Department of Veterans Affairs (VA) and commercial managed care settings.

Who was studied?

1285 patients with diabetes in the VA system and 6920 in commercial managed care systems. All patients spoke English or Spanish and lived in the community rather than in a nursing home or other institution.

How was the study done?

The researchers recruited patients with diabetes from 5 VA medical centers and 8 commercial managed care health plans. They asked patients questions about satisfaction with care and asked patients to rate their quality of care over the past year. The researchers also reviewed medical records to see how often patients had had blood tests and eye and foot checks and whether their medical conditions were well controlled. They then compared these variables between patients seen at VA and commercial managed care clinics.

What did the researchers find?

Patients in the VA system more often received blood tests to assess glucose control (hemoglobin A_1c), eye and foot checks, and counseling about aspirin use than did patients in commercial managed care. They also had better glucose and lipid level control than did patients in commercial managed care. Patients in both systems had poor blood pressure control. Patients in both systems also rated care highly and reported high satisfaction with care.

What were the limitations of the study?

The researchers could not contact all patients with diabetes who were followed at the sites. People who weren't contacted might have different opinions about their care. Much of the information was assessed by chart review. Some of the differences might reflect differences in chart documentation rather than actual differences in care that was received.

What are the implications of the study?

Patients with diabetes attending VA clinics probably received better care than did patients attending commercial managed care clinics.