|
|
|
| The Vermont Health Care Quality Report 2008 |
Ch2: Measuring Quality of Care Ch3: Chronic Illness in Vermont
|
|
Assessing the Quality of Care for Patients with Diabetes using AHRQ Quality Indicators (click for printable PDF) Diabetes is a disease in which the body does not produce enough insulin. Insulin allows blood sugar (glucose) to enter the body’s cells for energy. People with diabetes need to monitor their blood sugar levels carefully and adjust their diet and/or medications accordingly. Regular and careful monitoring and management of diabetes in the outpatient setting can often reduce the risk of developing complications from the disease and the need for hospitalization. The Agency for Healthcare Research and Quality (AHRQ) developed several measures that focus on the quality of care for individuals with diabetes. These include: uncontrolled diabetes, short-term complications, long-term complications, and lower-extremity amputation. Each measure specifically addresses complications resulting from poor control of diabetes. Examining these measures collectively provides an overall assessment of the quality of care to patients with diabetes.
The
measure that looks at Complication of Diabetes: Uncontrolled and
Short-term combines the two AHRQ indicators that address acute
complications of diabetes resulting from poor control. Poor control of
diabetes may lead to short-term complications such as blurred vision,
swelling of the brain, confusion, diabetic shock, and coma. If treated,
short-term complications are potentially reversible. When poor control
of diabetes is sustained the patient will develop more serious long-term
disorders of the kidneys, eyes, nerves, heart disease, and stroke.
Another long-term complication of diabetes is lower-extremity
amputation. The measure that looks at lower-extremity amputation is
reported as the number of patients with a lower-extremity amputation
procedure who also had diabetes. Lower-extremity amputation affects a
significant number of patients with diabetes and may be caused from an
infection, neuropathy, or microvascular disease. While these long-term
complications and lower extremity amputations are are irreversible, in
many cases they can be prevented or delayed. Proper outpatient treatment and adherence to treatment plans may reduce the incidence of hospitalization for complications of poor diabetes control. Lower rates may represent better quality care. Areas with high rates of hospitalization for uncontrolled diabetes may want to examine education practices, access to care, other potential causes of treatment failure, and utilization of hospitalization as a treatment option when interpreting this indicator. Discussion
Rates
are risk-adjusted by age and gender. Risk-adjusted rates represent the
number of admissions per 100,000 residents if the severity of illness in
every Vermont County was the same and was similar to a national
average. Risk-adjusted rates provide valid comparisons across
geographic areas. Risk-adjusted rates allow valid comparisons among
rates within Vermont, among The risk-adjusted rate of hospitalization for uncontrolled diabetes or short-term complications is considerably lower in Vermont compared to the national rate. Most of these hospitalizations were for short-term complications. Very few people are hospitalized with a diagnosis of uncontrolled diabetes without mention of short or long term complications.
These measures only include Vermont residents who were admitted to a Vermont hospital. It may be the case that some residents used an out-of-state hospital for these services. If a Vermont resident was hospitalized in an out-of-state hospital, the event is not included, and the rate of hospitalization will underestimate utilization of services received. In 2006, residents in Washington and Addison counties were more likely to be admitted to a Vermont hospital for uncontrolled or short-term complications of diabetes than other counties. Residents of Grand Isle and Windsor counties had a lower rate of hospitalization for poor control of diabetes.
In 2006, residents in Grand Isle and Bennington counties were more likely to be admitted to a Vermont hospital for diabetes long-term complications than other counties. Residents of Essex, Orange, and Windsor were less likely to be admitted to a Vermont hospital for diabetes long-term complications.
In 2006, diabetic patients in Essex and Rutland counties were more likely to be admitted to a Vermont hospital for lower-extremity amputation than other counties. Diabetic patients in Orange, Windsor, and Windham counties had a lower rate of hospitalization for lower-extremity amputation.
Looking at hospitalizations for complications of diabetes that might be prevented or delayed provides a window into the community and may lead to the identification of unmet healthcare needs. Addressing these needs, and providing effective and timely outpatient care, may help to avoid serious complications and use of costly resources such as hospitalization. For more information about the AHRQ Quality Indicators visit http://www.qualityindicators.ahrq.gov/index.htm |
|
