DOD
Search
Discussions
Biomedical Jobmarket
News
DOD Alert
Edit DOD
 
ACCOUNT
Login
Register
Forgotten Password?
 
 
Adherence to Guidelines and its Effects on Hospitalizations with Complications of Type 2 Diabetes
 
Diabetes OD > Disease Management > Compliance and Adherence > Journal Article

(Journal Article): Adherence to Guidelines and its Effects on Hospitalizations with Complications of Type 2 Diabetes
 
Sloan FA, Bethel MA, Lee PP, Brown DS, Feinglos MN (Center for Health Policy, Law, and Management and Department of Economics, Box 90253, Duke, fsloan(at)hpolicy.duke.edu )
 
IN: Rev Diabetic Stud 2004; 1(1):29-38
Impact Factor(s) of Rev Diabetic Stud: 0.125 (2006)

Fulltext:    HTML  PDF

ABSTRACT: OBJECTIVES: To study the discrepancy between actual and recommended rates of use among several measures of screening for complications of diabetes in a national longitudinal sample, the correlations among measures of adherence, and whether or not higher rates of adherence reduce hospitalizations for complications of diabetes. The key study hypothesis was that lack of adherence to professional recommendations for diabetes care leads to adverse health outcomes for elderly persons. METHODS: Administrative claims and survey data for 1994-­1999 on a nationally representative sample of Medicare beneficiaries age 65+. Principal components analysis and instrumental variables probit regression methods were used. RESULTS: Most Medicare beneficiaries diagnosed with type 2 diabetes had at least one physician visit per year, but rates of screening (eye examinations and HbA1c, lipid, microalbumin and urine tests) fell far short of recommendations. Correlations among use rates for various types of screening were positive but far less than one, suggesting that failure to screen reflects a complex set of underlying factors. Increased rates of adherence were observed for HbA1c and lipid testing over the observation period. Higher use was associated with lower rates of hospitalization for complications of diabetes (vascular (p=0.007), renal (p=0.002), and other complication (p=0.005)). CONCLUSIONS: Adherence to guidelines was associated with significantly reduced rates of hospitalization. Continued analysis of the trends in clinical practice is needed to demonstrate the effectiveness of standardized guidelines for the care of patients with diabetes.

TYPE OF PUBLICATION: Original article

REFERENCES:

  1. American Diabetes Association. Diabetes 2001 Vital Statistics. American Diabetes Association, Alexandria, VA, 2001. [DOD]
  2. National Diabetes Data Group. Diabetes in America. National Institutes of Health, National Institute of Diabetes and Diges-tive and Kidney Diseases, Bethesda, MD, 1995, 2nd ed. [DOD]
  3. Nathan DM, McKitrick C, Larkin M, Schaffran R, Singer DE. Glycemic control in diabetes mellitus: Have changes in therapy made a difference? Am J Med 1996. 100(2):157-63.
  4. Javitt JC, Aiello LP. Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996. 124 (1 Pt 2):164-169. [DOD]
  5. Vijan S, Hofer TP, Hayward RA. Estimated benefits of glycemic control in microvascular complications in type 2 diabetes. Ann Intern Med 1997. 127(9):788-795. [DOD]
  6. Vijan S, Hofer TP, Hayward RA. Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. JAMA 2000. 283(7):889-896. [DOD]
  7. American Diabetes Association. Clinical practice recommendations. Diabetes Care 1994-1998, Annual Supplements.
  8. American Academy of Ophthalmology. Policy Statement: Frequency of Ocular Examinations. San Francisco. American Academy of Ophthalmology 2000. http://www.aao.org/aao/ member/policy/exams.cfm (accessed 17 April 2003).
  9. American Optometric Association. Optometric clinical practice guideline: Comprehensive adult eye and vision examination. Reference guide for clinicians. American Optometric Association, St. Louis 1997, 2nd ed.: http://www.aoa.org/clincare/ pdf/1.pdf (accessed 17 April 2003).
  10. Health Employer Data and Information Set. 2001. http://www.ncqa/programs/HEDIS/ (accessed 22 January 2004).
  11. Martin TL, Selby JV, Zhang D. Physician and patient prevention practices in NIDDM in a large urban managed-care organization. Diabetes Care 1995. 18(8):1124-1132. [DOD]
  12. Weiner JP, Parente ST, Gamick DW, Fowles J, Lawthers AG, Palmer H. Variation in office-based quality: A claims-based profile of care provided to Medicare patients with diabetes. JAMA 1995. 273:1503-1508. [DOD]
  13. Coon P, Zulkowski K. Adherence to American Diabetes Association standards of care by rural health care providers. Diabetes Care 2002. 25(12):2224-2229. [DOD]
  14. Lee PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA. Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Ophthalmol 2003. 110(10):1952-1959. [DOD]
  15. Jencks SF, Huff ED, Cuerdon T. Changes in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA 2003. 289(3):305-312. [DOD]
  16. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. NEJM 2003. 348(26):2635-2645. [DOD]
  17. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Pract 2002. 19(4):344-349. [DOD]
  18. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999. 282(15):1458-1465. [DOD]
  19. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001. 158(1):29-35. [DOD]
  20. Hebert PL, Geiss LS, Tierney EF, Engelgau MM, Yawn BP, McBean AM. Identifying persons with diabetes using Medicare claims data. Am J Med Qual 1999. 14(6):270-277. [DOD]
  21. StatSoft, Inc. Principal Components and Factor Analysis. http://www.statsoftinc.com/textbook/stfacan.html (accessed Jan. 20, 2004).
  22. Dunteman GH. Principal Components Analysis. Sage Publications, Newbury Park, CA, 1989.
  23. Stata, Inc. Stata, Version 8.0. College Station, TX 2002.
  24. Newey W. Efficient estimation of limited dependent variable models. J Econom 1987. 36:231-250. [DOD]
  25. Greene WH. Econometric Analysis, 5 th ed. Prentice Hall Upper Saddle River, NJ, 2003.
  26. Smith RJ, Blundell RW. An exogeneity test for a simultaneous equation tobit model with an application to labor supply. Econometrica 1986. 54(4):679-686. [DOD]
  27. DxCG, Inc. DxCG risk adjustment software analytic guide, release 6.0. DxCG, Inc., Boston, MA, 2001.
  28. Ellis RP, Pope GC, Iezzoni LI, Ayanian JZ, Bate, DW, Burstin H, Ash AS. Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev 1996. 17:101-128. [DOD]
  29. Morgan CL, Currie CJ, Stott NC, Smithers M, Butler CC, Peters JR. The prevalence of multiple diabetes-related complications. Diabet Med 2000. 17(2):146-151. [DOD]
  30. Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes treatment on the development and progression of long-term complications in insulin dependent diabetes mellitus: The diabetes control and com-plications trial. NEJM 1993. 329:977-986. [DOD]
  31. United Kingdom Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with convention treatment and risk of complication in patients with type 2 diabetes (UKPDS 33). Lancet 1998. 352:837-853. [DOD]
  32. United Kingdom Prospective Diabetes Study Group. Effect of intensive blood- glucose control with metfomrin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998. 352: 854-865. [DOD]
  33. Kerr EA, Smith DM, Hogan MM, Hofer TP, Krein SL, Bermann M, Hayward RA. Building a better quality measure: Are some patients with “poor quality” actually getting good care? Med Care 2003. 41(10):1173-1182. [DOD]
  34. Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Zbrozek AS, Dong F, Manninen D, Garfield SA, Copley-Merriman C, Maier W, et al. Model of complications of NIDDM. I. Model construction and assumptions. Diabetes Care 1997. 20(5):725-734. [DOD]
  35. Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Copley-Merriman C, Maier W, Dong F, Manninen D, Zbrozek AS, Kotsanos J, et al. Early Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997. 20(5):735-744. [DOD]


 
Respond on this Journal Article!
Hint: Your Response should directly apply to Adherence to Guidelines and its Effects on Hospitalizations with Complications of Type 2 Diabetes. Please check, if this context applies best to your contribution. Otherwise click HERE to change to the appropriate subject area. The actual subject area is Compliance and Adherence.