Highlights

The Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) are pleased to release this report, Women With Diabetes: Report on Quality of Healthcare, on behalf of the U.S. Department of Health and Human Services (HHS). This report uses national data sets to show gaps in knowledge about quality of care among women with diagnosed diabetes. The report examines the quality of health care in the United States for women with and without diagnosed diabetes, using the most scientifically based measures and national data sources available. It presents 15 measures of health care quality showing the use of services in several areas: access to care, general well-being, evidence-based diabetes-specific preventive care, cardiovascular disease-specific preventive care, cancer-specific care, immunizations, and dental care.

This Highlights section offers a concise overview of findings from this report. The findings indicate that among women with and without diagnosed diabetes, disparities exist in access to and quality of care.

Access to Care

• Women with diagnosed diabetes were significantly more likely than women without diabetes to report having a usual source of care.
• Women under age 65 with diabetes were significantly more likely than those without diabetes to have only public insurance.
• Women with diagnosed diabetes were significantly more likely than women without diabetes to have reported an emergency room visit in the past year.

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Preventive Services

• Women with diagnosed diabetes were significantly less likely than women without diabetes to have had blood pressure less than 130/80 mm Hg.
• Women with diagnosed diabetes were significantly less likely than women without diabetes to have had a dental visit in the past year.
• Women with diagnosed diabetes were significantly more likely than women without diabetes to have received an influenza vaccination in the past 12 months, and significantly more likely to have ever received a pneumococcal vaccination. However, among women younger than age 65, only about 40% have been immunized against influenza and fewer than 40% have ever received a pneumococcal vaccination.

Measures of access to care and quality of care among women with diagnosed diabetes were selected from the annual National Healthcare Disparities Report (NHDR) published by AHRQ. The measures analyzed in this report are not necessarily a comprehensive and balanced set, due to data availability and other constraining factors for the diabetes population. All the measures used are evidence-based recommendations to prevent morbidity and mortality among adult women with and without diagnosed diabetes. The table below summarizes the findings, comparing how the American health care system provides care to women with diagnosed diabetes with how it provides care to women without diabetes and men with diagnosed diabetes.

For many of the measures presented in this report, adults with diabetes and women with diagnosed diabetes fared worse than their comparison groups. Even for measures with similar or better care, there is often room to improve the overall quality of and access to care. Nonetheless, these measures highlight where the American health care system excels and where the greatest opportunities for improvement are. This information identifies areas with greater need for programmatic efforts, policies, research, and services to address specific issues for women with diagnosed diabetes across the lifespan.

Table 1. Summary of Disparities by Diagnosed Diabetes Status and Gender

Level of Care	Women With Diagnosed Diabetes Compared With Women Without Diabetes	Women With Diagnosed Diabetes Compared With Men With Diagnosed Diabetes
Better	9 measures Access to Care Women with a usual source of care Women with a usual primary care provider Women with any type of insurance Women without insurance all year Women without insurance for any period Cardiovascular Disease-Specific Preventive Care Women who had a cholesterol check in the past 2 years Women who received advice to quit smoking Immunization Women who received an influenza vaccination in the past 12 months Women who ever received a pneumococcal vaccination 1 measure	1 measure Diabetes-Specific Preventive Care Adults whose hemoglobin A1c level was >9.0%
Same	3 measures Cancer-Specific Care Women who reported they had received a colorectal cancer screening Women who reported they had a mammogram Women who reported they had a Pap smear	15 measures Access to Care Adults with a usual source of care Adults with a usual primary care provider Adults with any type of insurance Adults without insurance all year Adults without insurance for any period Adults who reported an emergency room visit Adults who usually use public transportation to get to provider Diabetes-Specific Preventive Care Adults whose hemoglobin A1c level was <7.0% Adults who received all three recommended services for diabetes Cardiovascular Disease-Specific Preventive Care Adults who had a cholesterol check Adults with blood pressure less than 130/80 mm Hg Adults who received advice to quit smoking Immunization Adults who received an influenza vaccination in the past 12 months Adults who ever received a pneumococcal vaccination Other Complications Adults who reported a dental visit
Worse	8 measures Access to Care Women with private insurance Women with public insurance (no private insurance) Women with any period of public insurance Women who reported an emergency room visit Women who usually use public transportation to get to provider General Health and Well-Being Women with activity limitation Cardiovascular Disease-Specific Preventive Care Women with blood pressure less than 130/80 mm Hg Dental Care Women who reported a dental visit	5 measures Access to Care Adults with private insurance Adults with public insurance (no private insurance) Adults with any period of public insurance General Health and Well-Being Adults with activity limitation Cancer-Specific Care Adults who reported they had ever received a colorectal cancer screening

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