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Doctors Get Rated On Their Diabetes Care

Posted: Thursday, February 05, 2004

Thousands of patients have not been getting all the tests and screenings they need, new data show. This news will come in diabetes care "report cards" that doctors are getting in the mail. The confidential reports will show each doctor how many of his or her diabetes patients received four crucial tests in 2002 and how that compared with the overall level of testing provided by area doctors.

The local initiative is part of a national trend to provide doctors with ways to compare their care with that provided by the rest of the medical community.

The report cards are the work of the Kansas City Quality Improvement Consortium. The organization was created in 2000 by local medical societies, insurance companies and medical schools. In 2002 the consortium provided doctors with guidelines for treating common ailments, including diabetes, depression, asthma and heart failure. After evaluating this first report card on diabetes, the consortium plans to issue more report cards annually.

"This has tremendous importance," said Nathaniel Clark, a physician and national vice president of the American Diabetes Association. "The only way physicians can know if they're providing quality care is to measure that care and give the data back to them."

As Americans grow increasingly overweight, the prevalence of diabetes has increased at alarming rates. About 18 million adults now have the disease.

The report cards will show what percentage of diabetes patients in each physician practice received the monitoring tests that experts consider essential for diabetes control. These tests need to be done annually or more frequently:

• A blood test, called hemoglobin A1c, that shows long-term blood-sugar levels.

• A blood test measuring levels of LDL cholesterol, the "bad" cholesterol that clogs arteries.

• An eye exam to look for damage to the retina.

• A urine test to catch early signs of kidney damage.

"These tests are extremely critical. They can end up sparing a person his eyes and his kidneys," Clark said. "But we have study after study showing that a distressingly small percentage of patients are getting the care they need."

Of the 8,937 patients covered by the Kansas City report cards, 77 percent received the blood-sugar and cholesterol tests, 43 percent received the test for kidney damage and 35 percent received the eye exams in 2002.

The blood-sugar levels of 39 percent of the patients were poorly controlled. The data showed that cholesterol levels were controlled in 61 percent of patients.

As proof that doctors can do better, Laiben pointed to data the report cards include on the physicians who got top rankings from the consortium, whose practices account for 10 percent of the diabetes patients. More than 90 percent of these patients had received the needed blood tests. Only 7 percent of the patients had poorly controlled blood-sugar levels.

"Other things get focused on during the visit. You may be addressing their blood pressure or a pain problem. Something else takes precedence."

Local initiatives like the Kansas City Quality Improvement Consortium are becoming more common, said Brian Schilling, spokesman for the National Committee for Quality Assurance, the organization that accredits managed-care health plans and set the diabetes standards used in the report cards.

"One of the biggest stumbling blocks is getting physician support," Schilling said. "When they hear a physician evaluation is coming their way, it may not be welcomed."

Stephen Salanski, a consortium member and family physician in Kansas City, expects local doctors to be more receptive toward the report cards because doctors played a major role in developing them.

"The hope is they'll see this as a tool," he said. "Most doctors don't want to be just average on this data. They want to be in the top 10 percent."  

Source: Diabetes In Control.com.

 
 
 
 
 
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