Weiner J P, Parente S T, Garnick D W, Fowles J, Lawthers A G, Palmer R H
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA.
JAMA. 1995 May 17;273(19):1503-8. doi: 10.1001/jama.273.19.1503.
To demonstrate that claims data "profiling" can be used as an ongoing method to support ambulatory care quality improvement; to measure the quality of office-based care provided to elderly patients with diabetes in three states; and to identify factors associated with better attainment of quality standards.
A cross-sectional study based on a 100% sample of the Medicare claims (Part B and Part A) submitted between July 1, 1990, and June 30, 1991.
All primary care practices (both solo and group) actively seeing Medicare patients with diabetes in Alabama, Iowa, and Maryland (n = 2980).
All elderly (> or = 65 years) Medicare patients seen by the study physicians and assigned a diagnosis of diabetes (n = 97,388) by any office-based physician during the year.
The proportion of patients with diabetes receiving the following procedures (from any provider) at least once during the study period: hemoglobin A1C measurement, ophthalmologic examination, total cholesterol measurement, and blood glucose measurement. We considered the first three services to be optimally recommended and blood glucose measurement to be of limited use.
Based on analyses of services provided in the ambulatory setting, we found that 84% of diabetics did not appear to receive the recommended hemoglobin A1C measurement, 54% did not see an ophthalmologist, and 45% received no cholesterol screening. Practice patterns varied considerably across the three states (up to 2.38-fold), even after adjusting for patient case mix and physician characteristics. Patients of general practitioners were less likely to meet recommended quality criteria than patients of internists or family practitioners. Patients receiving care from rural practitioners were less likely to receive services, either recommended or not, than those in urban locations.
Elderly patients with diabetes do not appear to be receiving optimal care. This study underscores the value of practice guideline development and dissemination in the ambulatory arena. This study provides substantial evidence that existing administrative claims data can be used to support ambulatory quality improvement activities.
证明索赔数据“剖析”可作为一种持续的方法来支持门诊医疗质量的改善；衡量三个州为老年糖尿病患者提供的门诊医疗服务质量；并确定与更好地达到质量标准相关的因素。
一项横断面研究，基于1990年7月1日至1991年6月30日期间提交的100%医疗保险索赔（B部分和A部分）样本。
阿拉巴马州、爱荷华州和马里兰州所有积极接待患有糖尿病的医疗保险患者的初级医疗诊所（包括单人诊所和团体诊所）（n = 2980）。
研究医生诊治的所有年龄≥65岁的老年医疗保险患者，且在当年被任何门诊医生诊断为糖尿病（n = 97388）。
在研究期间，患有糖尿病的患者（由任何提供者提供服务）至少接受以下检查一次的比例：糖化血红蛋白测量、眼科检查、总胆固醇测量和血糖测量。我们认为前三项服务为最佳推荐，而血糖测量的作用有限。
基于对门诊服务的分析，我们发现84%的糖尿病患者似乎未接受推荐的糖化血红蛋白测量，54%未看眼科医生，45%未接受胆固醇筛查。即使在对患者病例组合和医生特征进行调整后，三个州的医疗模式仍有很大差异（高达2.38倍）。与内科医生或家庭医生的患者相比，全科医生的患者不太可能达到推荐的质量标准。与城市地区的患者相比，接受农村医生治疗的患者接受推荐或非推荐服务的可能性较小。
老年糖尿病患者似乎未得到最佳治疗。本研究强调了在门诊领域制定和传播实践指南的价值。本研究提供了大量证据，表明现有的行政索赔数据可用于支持门诊质量改进活动。
