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Receipt of Recommended Interventions for Diabetes Management
The NHQR tracks the national intervention rates for each of five recommended diabetes interventions as well as a composite of the respondents who received all five interventions.
Figure 2.4. Adults age 18 and over with diabetes who received HbA1c test, lipid profile, retinal exam, foot exam, and influenza vaccination, and rate for receipt of all five tests, 2001
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001.
- Approximately one-third of adults with diabetes received all five interventions recommended for comprehensive diabetes care in 2001 (Figure 2.4).
- The national rate for HbA1c testing at least once annually for adults with diabetes age 18 and over was nearly 90% in both 2000 and 2001.
- In 2001, nearly 94% of diabetics had a lipid profile sometime in the previous 2 years. Although controlling cholesterol can significantly reduce the risk for cardiovascular disease in individuals with diabetes, about 60% have their most recent LDL cholesterol at a minimally acceptable level of <130 mg, and 32% have it at an optimal level of <100 mg, up from 8% in 1988-94 (National Health and Nutrition Examination Survey [NHANES], 1999-2000).
- In 2001, only two-thirds of people with diabetes reported having regular foot exams in the past year. People with diabetes account for over 60% of nontraumatic lower extremity amputations; foot care and preventive exams can reduce rates of such amputation by 45%-85%1. All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions5.
- People with diabetes are considered at an increased risk for complications from influenza. Just over half of adults (56.5%; see Tables Appendix, Table 1.19a) with diabetes received an influenza vaccination in 2001.
State Variation in HbA1c Testing
Variation across the country is one measure of the consistency with which care is offered. Examining State variation in diabetes testing rates can offer lessons on opportunities for improvement.
Figure 2.5. State variation in rates of receipt of HbA1c testing for adults, 2002
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Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2002.
- Performance is high across the country relative to other diabetes measures. Half of the reporting States had rates that were not statistically different from the mean of the top decile of States (94.2%) and nearly a quarter of reporting States had rates over 90% (Figure 2.5).
- The State rates of reporting States for at least one HbA1c test for people with diabetes in 2002 ranged from 77.1% to 96.3%. Variation across States is lower for this measure than other diabetes quality measures—retinal exams, foot exams, and influenza immunization.
- Uniformly high performance is not seen when assessing the percentage of patients having two or more HbA1c tests per year (a standard tracked by BRFSS). State averages of reporting States are more varied than for one or more times per year, ranging from 53.4% to 82.6%i.
- Although the HbA1c testing rates for most reporting States did not change significantly between 2001 and 2002, South Carolina, West Virginia, and Wyoming each showed significant improvement over their previous rates.
Hospital Admissions for Long-term Diabetes Complications
Admissions for conditions that can be managed in an outpatient setting is one indicator of the effectiveness and timeliness of outpatient care. Quality diabetes care captured in the NHQR diabetes process measures will ideally result in lower admissions for long-term complications. However, admissions for diabetes may also be an indicator of access to care, patient compliance, and other factors. Long-term complications include renal, eye, neurological, circulatory, or complications not otherwise specified and do not include pregnancy-related diabetes.
Figure 2.6. Adult admissions per 100,000 population 18 and over (general population) for long-term complications of diabetes, by region, 2001
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Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2001.
- The estimated national rate of hospital admissions of the general population for long-term complications of diabetes in 2001 was just over 117 per 100,000 adult population.
- There is significant variation across regions with regard to hospital admissions for long-term diabetes complications. Admission rates in the Northeast and South are approximately 16% higher than in the Midwest and 47% higher than in the West (Figure 2.6). This measure is influenced by State variation on diabetes prevalence.
- Individuals living in areas with a median income of less than $25,000 per year are hospitalized for long-term complications more than twice as often as those living in areas with median income of $45,000 or more.
- The difference in hospital admissions for long-term complications between men and women is highly significant, with women 22% less likely than men to be admitted.
iAlaska's rate is 42.9%, SE=11.8 and N=129. Because of the large standard error and small N, this rate is left out of the range of values.