Adherence to quality of care measurements among 58,182 patients with new onset diabetes and its association with mortality

Disease registry for diabetes care encourages transparency and benchmarking of quality of care (QoC) measurements for all service providers and seems to improve diabetes care. This study evaluate changes over time in QoC measurement performance in a large diabetes registry among newly diagnosed diab...

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Published in:PloS one 2018-12, Vol.13 (12), p.e0208539-e0208539
Main Authors: Hemo, Beatriz, Shahar, Danit R, Geva, Dikla, Heymann, Anthony D
Format: Article
Language:English
Subjects:
Automation
Biology and Life Sciences
Blood Pressure
Body mass
Cancer
Confidence intervals
Creatinine
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - mortality
Diagnosis
Female
Glucose
Glycated Hemoglobin - analysis
Health care policy
Health maintenance organizations
Health sciences
Hemoglobin
HMOs
Hospitals
Humans
Hypoglycemic Agents - therapeutic use
Insulin
Laboratories
Low density lipoprotein
Male
Medical diagnosis
Medicine and Health Sciences
Middle Aged
Mortality
Patient compliance
Patients
Proportional Hazards Models
Public health
Quality
Quality of care
Quality of Health Care
Registries
Retrospective Studies
Risk Factors
Statistical analysis
Survival Rate
Transparency
Treatment Adherence and Compliance
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Geva, Dikla
Heymann, Anthony D
description Disease registry for diabetes care encourages transparency and benchmarking of quality of care (QoC) measurements for all service providers and seems to improve diabetes care. This study evaluate changes over time in QoC measurement performance in a large diabetes registry among newly diagnosed diabetics and it association with mortality. Retrospective cohort study of patients in a large health maintenance organization diabetes registry from years 2000 to 2013. We identified 58,182 patients diagnosed with diabetes from 2000-2008 and examined the level of performance for seven QoC measurements (HbA1c, LDL, albumin-creatinine-ratio, fundus/foot examinations, BMI and Blood-pressure) at diagnosis year. We also searched data regarding visits to dietitians or endocrinologists, and purchase of diabetes and statin medications. We used Mantel-Haenszel's χ2 test to assess QoC performance and mortality rate by calendar year of entry into the registry, and Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality up to 5 years from diagnosis adjusted for age, gender, socio-economic status and comorbidities. The total QoC measurements improved from a mean of 2.71 tests performed in 2000 to 5.69 in 2008 (p
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This study evaluate changes over time in QoC measurement performance in a large diabetes registry among newly diagnosed diabetics and it association with mortality. Retrospective cohort study of patients in a large health maintenance organization diabetes registry from years 2000 to 2013. We identified 58,182 patients diagnosed with diabetes from 2000-2008 and examined the level of performance for seven QoC measurements (HbA1c, LDL, albumin-creatinine-ratio, fundus/foot examinations, BMI and Blood-pressure) at diagnosis year. We also searched data regarding visits to dietitians or endocrinologists, and purchase of diabetes and statin medications. We used Mantel-Haenszel's χ2 test to assess QoC performance and mortality rate by calendar year of entry into the registry, and Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality up to 5 years from diagnosis adjusted for age, gender, socio-economic status and comorbidities. The total QoC measurements improved from a mean of 2.71 tests performed in 2000 to 5.69 in 2008 (p&lt;0.001). The mortality rate dropped from 7.7% in 2000 to 5.7% in 2008 (p&lt;0.001). Patients with more QoC measurements performance who visited a dietitian and purchased statin medications had a lower mortality risk (HRs (95% CIs) 0.89 (0.87-0.92), 0.83 (0.76-0.91) and 0.70(0.65-0.75) respectively). Visits to endocrinologists and purchases of oral diabetes medication and insulin were associated with a higher risk of mortality (HRs (95% CIs) 1.20(1.07-1.35), 1.35(1.26-1.46) and 3.36(2.92-3.87) respectively). Performance of QoC measurements including visiting a dietitian and purchase of statin medications were associated with lower mortality in patients with diabetes. 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This study evaluate changes over time in QoC measurement performance in a large diabetes registry among newly diagnosed diabetics and it association with mortality. Retrospective cohort study of patients in a large health maintenance organization diabetes registry from years 2000 to 2013. We identified 58,182 patients diagnosed with diabetes from 2000-2008 and examined the level of performance for seven QoC measurements (HbA1c, LDL, albumin-creatinine-ratio, fundus/foot examinations, BMI and Blood-pressure) at diagnosis year. We also searched data regarding visits to dietitians or endocrinologists, and purchase of diabetes and statin medications. We used Mantel-Haenszel's χ2 test to assess QoC performance and mortality rate by calendar year of entry into the registry, and Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality up to 5 years from diagnosis adjusted for age, gender, socio-economic status and comorbidities. The total QoC measurements improved from a mean of 2.71 tests performed in 2000 to 5.69 in 2008 (p&lt;0.001). The mortality rate dropped from 7.7% in 2000 to 5.7% in 2008 (p&lt;0.001). Patients with more QoC measurements performance who visited a dietitian and purchased statin medications had a lower mortality risk (HRs (95% CIs) 0.89 (0.87-0.92), 0.83 (0.76-0.91) and 0.70(0.65-0.75) respectively). Visits to endocrinologists and purchases of oral diabetes medication and insulin were associated with a higher risk of mortality (HRs (95% CIs) 1.20(1.07-1.35), 1.35(1.26-1.46) and 3.36(2.92-3.87) respectively). Performance of QoC measurements including visiting a dietitian and purchase of statin medications were associated with lower mortality in patients with diabetes. It may be that the early active involvement of the patients in their care plays a protective role in long term mortality.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30540832</pmid><doi>10.1371/journal.pone.0208539</doi><orcidid>https://orcid.org/0000-0001-6657-2106</orcidid><oa>free_for_read</oa></addata></record>
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1932-6203
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source PMC (PubMed Central); Publicly Available Content (ProQuest)
subjects Automation
Biology and Life Sciences
Blood Pressure
Body mass
Cancer
Confidence intervals
Creatinine
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - mortality
Diagnosis
Female
Glucose
Glycated Hemoglobin - analysis
Health care policy
Health maintenance organizations
Health sciences
Hemoglobin
HMOs
Hospitals
Humans
Hypoglycemic Agents - therapeutic use
Insulin
Laboratories
Low density lipoprotein
Male
Medical diagnosis
Medicine and Health Sciences
Middle Aged
Mortality
Patient compliance
Patients
Proportional Hazards Models
Public health
Quality
Quality of care
Quality of Health Care
Registries
Retrospective Studies
Risk Factors
Statistical analysis
Survival Rate
Transparency
Treatment Adherence and Compliance
title Adherence to quality of care measurements among 58,182 patients with new onset diabetes and its association with mortality
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