Kuo S, Flemming B, Han L, Gittings N, Roman S, Geiss L; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1586.
Mathematica Policy Research, , 50 Church St., 4th Floor, Cambridge, MA 02138 Tel. 617-491-7900 X 274 Fax 617-491-8044
RESEARCH OBJECTIVE: To describe rates of complications and receipt of associated preventive services among Medicare diabetic claimants and to document how these trends have varied over time and across different demographic subgroups. This effort is part of the Medicare Quality Monitoring System designed to monitor the quality of care received by Medicare beneficiaries. STUDY DESIGN: Using the Medicare 5% Standard Analytic Files, rates on 24 quality indicators associated with diabetes were reported for Medicare diabetic claimants. These measures were identified using claims with specific ICD-9, CPT/HCPSC and Revenue Center codes. Rates were generated for a 5% cross-sectional sample for 1992 and 2001, and were stratified by demographic and enrollment characteristics of the sample. Rates were reported as a percent of Medicare diabetic claimants with any claim during the year associated with that measure. The rates and standard errors were age-sex standardized to control for variations in the age-sex distribution across the two years. POPULATION STUDIED: The sample includes full-year fee-for-service Medicare diabetic claimants without end stage renal disease from 1992 through 2001. Diabetic claimants are defined as those who had either an inpatient or emergency department visit or two ambulatory encounters coded for diabetes during the year. Beneficiaries who died during the year were excluded, as were individuals who had gestational diabetes. The resulting sample sizes were 148,864 claimants for 1992 and 227,541 for 2001. PRINCIPAL FINDINGS: The use of preventive services (HbA1c tests, lipid tests, eye exams, and self-monitoring of glucose levels) increased greatly from 1992 to 2001. Additionally, rates for many of the short-term and serious long-term complications to diabetes (e.g. lower limb amputations and most cardiovascular conditions) declined from 1992 to 2001. However, other types of complications increased slightly during the period studied (e.g. osteomyelitis and most eye complications). Further, subgroup analyses demonstrated consistently higher complication rates and lower use of preventive services among non-whites and Medicare beneficiaries who were also enrolled in Medicaid. CONCLUSIONS: These analyses demonstrate significant progress over time in some key areas, such as in the receipt of preventive services and in some serious adverse diabetic outcomes. More research is needed to determine whether the increase in other types of complications reflect quality improvements through delayed disease progression or presage future prevalence of more serious outcomes. Additionally, the results suggest possible disparities in the quality of care for non-whites and Medicare beneficiaries who were also enrolled in Medicaid. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: These results provide an early warning sign to policymakers to focus attention on the diabetes care provided to some vulnerable subgroups, but also suggest some successes, such as in achieving reductions in lower limb amputations.
Publication Types:
Keywords:
- Amputation
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- Diabetes, Gestational
- European Continental Ancestry Group
- Fee-for-Service Plans
- Female
- Medicaid
- Medicare
- Pancreatic Diseases
- Pregnancy
- Prevalence
- Quality Indicators, Health Care
- economics
- methods
- surgery
- hsrmtgs
UI: 103624620
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