Impact of Self-Reported Patient Characteristics U,on Assessment of Glycemic Control in the Veterans Health  

Oleh:

Maney, Miriam ; Tseng, Chin-Lin ; Safford, Monika M. ; Miller, Donald R. ; Pogach, Leonard M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 30 no. 02 (Feb. 2007), page 245.

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

OBJECTIVE - The purpose of this article was to evaluate the impact of self-reported patient factors on quality assessment of Veterans Health Administration medical centers in achieving glycemic control. IISIARCH DESIGN AND METHODS - We linked survey data and administrative records for veterans who self-reported diabetes on a 1999 national weighted survey. Linear regression models were used to adjust AIC levels in fiscal year 2000 for socioeconomic status (education level, employment, and concerns of having enough food), social support (marital statUs and living alone), health behaviors (smoking, alcohol use, and exercise level), physical and mental health status, BMI, and diabetes duration. Medical centers were ranked by deciles, with and without adjustment for patient characteristics, on proportions of patients achieving AIC <7 or <8%. RESULTS - There was substantial medical center level variation in patient characteristics of the 56,740 individuals from 105 centers, e.g., grade school education (mean 15.3% [range 23-32.7%]), being retired (38.3% [19.9-59.7%]) or married (65.2% [43.7-77.8%]), food insufficiency 03.9% [7.2-24.6%]), and no reported exercise (43.2% [31.1-53.6%]). The final model had an R2 of7 .8%. The Spearman rank coefficient comparing the thresholds adjusted only forage and sex to the full model was 0.71 for <7% and 0.64 for <8% (P < 0.000l). After risk adjustment, 4 of the II best-performing centers changed at least two deciles for the <7% threshold, and 2 of II changed two deciles for the <8% threshold. CONCLUSIONS - Adjustment for patient self-reported socioeconomic status and health impacts medical center rankings for glycemic control, suggesting the need for risk adjustment to assure valid inferences about quality.

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