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Comparison of Medicine Resident Diabetes Care Between Veterans Affairs and Academic Health Care Systems
Journal of General Internal Medicine, 06/29/09

Powers BJ et al. - Compared to the VA, patients in the AHS were more likely to be younger, female, have fewer medications, and be treated with insulin, but had less comorbidity. Patients in the VA were more likely to be referred for an annual eye exam (94% vs. 78%), receive lipid screening (88% vs. 74%), receive proteinuria screening (63% vs. 34%), and receive a complete foot exam (85% vs. 32%) in analyses adjusted for patient demographics and comorbidities. In adjusted analyses, there were no significant differences in HbA1c, blood pressure, or LDL cholesterol control. In spite of similar resident providers and practice models, there were substantial differences in the diabetes quality of care delivered in the VA and AHS. Understanding how these factors influence subsequent practice patterns is an important area for study.

Exclusive Author Commentary
Benjamin J. Powers, 06/30/09

The quality measures we evaluated are appropriate for evaluating diabetes care because they are our best link to preventable patient-important outcomes; however, our findings suggest that these quality measurements better reflect the design and organization of the healthcare system rather than the knowledge or aptitude of an individual provider. This is particularly important as provider report cards are proposed as means to evaluate and allocate performance pay for primary care providers. While our results suggest continued room for improvement in chronic disease care, it is also encouraging that provider practice patterns for diabetes care are significantly shaped and potentially improved by high quality systems of care.