Tuesday, December 1, 2009

Diabetes Quality of Care

AHRQ (the US Agency for Healthcare Research and Quality) recently published an analysis of the quality of diabetes care across the country. The numbers are (still) not good. 7.4% of Americans (16.5 million people) have been told they have diabetes. (Probably another 8 million don't even know it.) Among seniors, the rate goes up to 18.3%.

Only a third of diabetic patients have had the 3 basic tests (an A1C test, an eye exam, and a foot exam) in the last year. The AHRQ didn't even report on cholesterol, kidney function, urine tests or the fact that good care requires 2 to 4 A1C tests per year - not just one.

So, we're still not applying the good science we have about diabetes to the benefit of Americans with the disease. Why not? Lots of reasons including access to care (read health insurance), patient factors (language or cultural barriers, fear, ignorance, illegal residence, etc.), conflicts with other health and personal needs (work, family, etc.), and poor systems of care. We still don't use the tools we have (computers, checklists, flowsheets, reminders and the rest) to ensure that basic needs get met with regularity.

There is hope as more and more people realize the tremendous waste of lives and money associated with sloppy care. The solutions are fast, cheap and easy, but they do require thinking about systems of care, not just visits, and about small investments that yield big savings.

The full report is available for free: Soni, A. Diabetes Management: Tests and Treatments among the Adult U.S. Civilian Noninstitutionalized Population, 2007. Statistical Brief #269. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st269/stat269.shtml

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