Quality of Diabetes Care in U.S. Academic Medical Centers

Grant, Richard W.; Buse, John B.; Meigs, James B.; for the University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team

doi:10.2337/diacare.28.2.337

Cited by 311Diabetes Management and EducationDiabetes Management and ResearchPrimary Care and Health Outcomes

Quality of Diabetes Care in U.S. Academic Medical Centers

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Grant, Richard W., Buse, John B., Meigs, James B., for the University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team·2005·Diabetes Care

DOI 10.2337/diacare.28.2.337PMC PMC3829636

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Abstract

OBJECTIVE— To assess both standard and novel diabetes quality measures in a national sample of U.S. academic medical centers. RESEARCH DESIGN AND METHODS— This retrospective cohort study was conducted from 10 January 2000 to 10 January 2002. It involved 30 U.S. academic medical centers, which contributed data from 44 clinics (27 primary care clinics and 17 diabetes/endocrinology clinics). For 1,765 eligible adult patients with type 1 or type 2 diabetes with at least two clinic visits in the 24 months before 10 January 2002, including one visit in the 6 months before 10 January 2002, we assessed measurement and control of HbA1c, blood pressure, and cholesterol and corresponding medical regimen changes at the most recent clinic visit. RESULTS— In this ethnically and economically diverse cohort, annual testing rates were very high (97.4% for HbA1c, 96.6% for blood pressure, and 87.6% for total cholesterol). Fewer patients were at HbA1c goal (34.0% <7.0%) or blood pressure goal (33.0% <130/80 mmHg) than lipid goals (65.1% total cholesterol <200 mg/dl, 46.1% with LDL cholesterol <100 mg/dl). Only 10.0% of the cohort met recommended goals for all three risk factors. At the most recent clinic visit, 40.4% of patients with HbA1c concentrations above goal underwent adjustment of their corresponding regimens. Among untreated patients, few with elevated blood pressure (10.1% with blood pressure >130/80 mmHg) or elevated LDL cholesterol (5.6% with LDL >100 mg/dl) were started on corresponding therapy. Patients with type 2 diabetes were no less likely to be intensified than patients with type 1 diabetes. CONCLUSIONS— High rates of risk factor testing do not necessarily translate to effective metabolic control. Low rates of medication adjustment among patients with levels above goal suggest a specific and novel target for quality improvement measurement.

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Factors other than patient behavior-such as adequacy of medical management, diabetes duration, weight gain, comorbid illness, concomitant medication, poverty, access to care, and health insurance coverage-affect diabetes treatment outcomes.
“Multiple factors other than patient behavior affect diabetes treatment outcomes, including adequacy of medical management, duration of diabetes, weight gain, and other health-related (e.g., comorbid illness and concomitant medication) and social-structural factors (e.g., poverty, access to care, health insurance coverage) (13–16).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [13]

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J.B.: Quality of diabetes care in U.S. academic medical centers: Low rates of medical regimen change. Diabetes Care 28
Grant, R. W., Buse, J. B., & Meigs, J. B. (2005)
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Quality of Diabetes Care in U.S. Academic Medical Centers: Low rates of medical regimen change
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Quality and effectiveness of diabetes care for a group of patients in Colombia
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Quality and effectiveness of diabetes care for a group of patients in Colombia Calidad y eficacia de la atención a diabéticos en un grupo de pacientes de Colombia
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Process measures and outcome research as tools for future improvement of diabetes treatment quality.
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Authors: Grant, R. W., Buse, J. B., Meigs, J. B., & for the University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team
Affiliations: Harvard University (US)
University of North Carolina at Chapel Hill (US)
ORCID: Grant, Richard W.
Buse, John B.
Meigs, James B.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2005-02-01
Volume: 28
Issue: 2
Pages: 337-442
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.28.2.337
PMC: PMC3829636
OpenAlex: W2130203112
Cited by: 311
References: 39
Citations by year: 2026: 2 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 2 · 2019: 8 · 2018: 7 · 2017: 5 · 2016: 12 · 2015: 13 · 2014: 18 · 2013: 23 · 2012: 22
FWCI: 22.76
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (K23DK067452)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords: diabetes care quality, academic medical centers, HbA1c control, blood pressure control, cholesterol management, metabolic control, medication intensification, type 1 diabetes, type 2 diabetes, quality improvement measures, primary health centers, endocrinology clinic
MeSH terms: Academic Medical Centers, Adult, Aged, Blood Pressure, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Cholesterol, LDL, Male, Middle Aged, Quality of Health Care, Retrospective Studies, Risk Factors, United States, Cohort Studies

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