Disease Management & Health Outcomes

, Volume 12, Issue 5, pp 285–298 | Cite as

National Performance Measures for Diabetes Mellitus Care

Implications for Health Care Providers
  • Fevzi Akinci
  • Joseph Coyne
  • Bernard Healey
  • Joni Minear
Review Article

Abstract

When considering the trends in disease management, the focus of healthcare in the US has shifted from communicable diseases, which can most often be managed successfully, to chronic diseases, which are currently not managed very well. Chronic diseases, such as diabetes mellitus, become a lifelong health problem for the individual, the family, and in the workplace. Currently, there is no vaccine to prevent diabetes and no cure for diabetes once acquired. In order to improve the quality of care for diabetes, national performance measures have been developed to provide a unified set of diabetes-specific performance and outcome measures.

The Diabetes Quality Improvement Project (DQIP) founded in 1997 through a partnership between the Center for Medicare and Medicaid Services, the National Committee for Quality Assurance, and the American Diabetes Association, established a single, standardized set of performance measures for diabetes care quality improvement and accountability in the US, which were published in 1998. The DQIP measures are noteworthy as a model for many other chronic diseases. Indeed, the DQIP represents the first widely adopted comprehensive performance measurement standards, not just for diabetes but for any single chronic disease. This is of further significance since it was developed by a coalition of public and private entities in the US.

In order to prevent long-term complications from diabetes, there needs to be a physician-coordinated treatment plan involving a team approach to the problem. When such a physician-coordinated treatment plan is developed in conformance with the comprehensive performance measures, the prospects for a greater impact on diabetes might be enhanced.

Overall, national performance measures for diabetes care have been widely adopted into health plan quality initiatives and have resulted in increased efforts to promote preventative screening and testing. Better compliance has lead to more stringent glucose control and helped to educate the public on the utility of the glycosylated hemoglobin level test for finding those at risk for microvascular and neuropathic complications. While more Americans with diabetes are receiving the recommended standards of care as a result of the implementation of national performance measures, diabetes management remains suboptimal but achievable.

The authors concluded from this review that national performance measures have provided health plans and providers with objective tools to measure quality; however, these measures now need to move to prevention standards and initiatives. Policy development for diabetes care must continue to move from managing chronic illness to preventative screening of pre-diabetes through to identification and modification of lifestyle risk factors.

Keywords

Health Plan HbA1c Level American Diabetes Association Diabetes Care National Quality Forum 

Notes

Acknowledgments

The authors gratefully acknowledge the careful review, insightful comments, and suggestions of reviewers on an earlier version of this review.

The authors also wish to acknowledge the bibliographical and editorial contributions of Ms Jill Royston, WSU Health Policy and Administration Department Program Assistant and the bibliographical development and refinement work by Mr Dan Simonson, Washington State University Graduate Student in the Health Policy and Administration Department. The authors received no funding for this manuscript and do not have any conflicts of interest to the content of this review.

References

  1. 1.
    The National Quality Forum. National voluntary consensus standards for adult diabetes care: a consensus report. Washington, DC: National Forum for Health Care Quality Measurement and Reporting, 2002Google Scholar
  2. 2.
    Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050. Diabetes Care 2001; 24(11): 1936–40PubMedCrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Diabetes: disabling, deadly, and on the rise 2002. Atlanta (GA): National Center for Chronic Disease Prevention and Health Promotion, 2002Google Scholar
  4. 4.
    Centers for Disease Control and Prevention. Making a difference: the business community takes on diabetes. Atlanta (GA): US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1999. Report no.: NDPD pub #33Google Scholar
  5. 5.
    National Committee for Quality Assurance (NCQA). Diabetes quality improvement project initial measure set (final version) [online]. Available from URL: http://www.ncqa.org/DPRP/dqip2.htm [Accessed 2003 May 19]
  6. 6.
    Acton KJ, Shields R, Rith-Najarian S, et al. Applying the diabetes quality improvement project indicators in the Indian Health Services primary care setting. Diabetes Care 2001; 24(1): 22–6PubMedCrossRefGoogle Scholar
  7. 7.
    Marshall CL, Bluestein M, Chapin C, et al. Outpatient management of diabetes mellitus in five arizona medicare managed care plans. Am J Med Qual 1996; 11: 87–93PubMedCrossRefGoogle Scholar
  8. 8.
    Selecky C. Integrating technology and interventions in the management of diabetes, practical disease management. Dis Manage Health Outcomes 2001; 9 Suppl. 1: 39–52Google Scholar
  9. 9.
    Berg GD, Wadhwa S. Diabetes disease management in a community-based setting, managed care. Manag Care 2002; 11(6): 42–50PubMedGoogle Scholar
  10. 10.
    Fleming BB, Greenfield S, Engelgau MM, et al. The diabetes quality improvement project. Diabetes Care 2001; 24(10): 1815–20PubMedCrossRefGoogle Scholar
  11. 11.
    McLaughlin S. The diabetes quality improvement project. Diabetes Spectrum 2000; 13(1): 5–11Google Scholar
  12. 12.
    The American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, and the National Committee for Quality Assurance. Desirable attributes of performance measures: physician consortium for performance improvement: a consensus document from AMA, JCAHO, and NCQA [online]. Available from URL: http://www.ama-assn.org/amal/pub/upload/mm/370/attributes.pdf [Accessed 2003 May 27]
  13. 13.
    The American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, and the National Committee for Quality Assurance. Principles for performance measurement in health care: physician consortium for performance improvement: a consensus statement from AMA, JCAHO, and NCQA [online]. Available from URL: http://ama-assn.org/amal/pub/upload/mm/370/principlesperfmeas.pdf [Accessed 2003 May 27]
  14. 14.
    The American Medical Association (AMA) website. Available from URL: http://www.ama-assn.org.amal/pub/upload/mm/370/diabetes.pdf [Accessed 2003 May 27]
  15. 15.
    American Diabetes Association. Clinical practice recommendations 1999. Diabetes Care 1999; 22 Suppl. 1: S1–114Google Scholar
  16. 16.
    American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25(1): 213–29CrossRefGoogle Scholar
  17. 17.
    The National Committee for Quality Assurance news release. AMA, JCAHO, and NCQA release common measures for diabetes care [online]. Available from URL: http://www.ncqa.org/communications/news.htm [Accessed 2003 May 27]
  18. 18.
    The National Quality Forum press release. National consensus standards endorsed for monitoring the quality of care for diabetes [online]. Available from URL: http://www.qualityforum.org/prdiabetes10-01-02FINAL.pdf [Accessed 2003 May 27]
  19. 19.
    The US Office of Management and Budget website [online]. Available form URL: http://www.whitehouse.gov/omb [Accessed 2003 May 27]
  20. 20.
    Centers for Disease Control and Prevention. Promising practices in chronic disease prevention and control 2003: a public health framework for action. Atlanta (GA): Department of Health and Human Services, 2003Google Scholar
  21. 21.
    Knowler WC, Barret-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393–403PubMedCrossRefGoogle Scholar
  22. 22.
    Woolhandler S, Himmelstein DU, Angell M, et al. Physicians’ Working Group for single-payer national health insurance. JAMA 2003; 290(6): 798–805PubMedCrossRefGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention. The CDC Fact Book 2000–2001. Atlanta (GA): Division of Health Interview Statistics, 2000 SepGoogle Scholar
  24. 24.
    Tuomilehto JLJ, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343–50PubMedCrossRefGoogle Scholar
  25. 25.
    Krein SL, Hofer TP, Kerr EA, et al. Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups, and health care facilities. Health Serv Res 2002; 37(5): 1159–80PubMedCrossRefGoogle Scholar
  26. 26.
    Late M. Literacy status among major predictors of healthiness [letter]. The Nation’s Health 2003 Jun/JulGoogle Scholar
  27. 27.
    Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Bood Pressure (JNC VI). Arch Intern Med 1997; 157: 2413–46CrossRefGoogle Scholar
  28. 28.
    UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13CrossRefGoogle Scholar
  29. 29.
    Hansson L, Zanchett A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin on patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755–62PubMedCrossRefGoogle Scholar
  30. 30.
    TRIAD Study Group. The Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care 2002; 25(2): 386–9CrossRefGoogle Scholar
  31. 31.
    Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA 2003; 28(4): 434–41CrossRefGoogle Scholar
  32. 32.
    NCQA. Making a difference: recognizing and rewarding excellence. Washington, DC: NCQA, 2002Google Scholar
  33. 33.
    Friis R, Sellers T. Epidemiology for public health practice. 3rd ed. Sudbury (MA): Jones and Bartlett Publishers, 2004Google Scholar
  34. 34.
    Ross A, Wenzel F, Mitlyng J. Leadership for the future: core competencies in healthcare (2002). Chicago (IL): Health Administration Press, 2002Google Scholar
  35. 35.
    Saaddine JB, Engelgau MM, Beckles GL, et al. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 2002; 136(8): 565–74PubMedGoogle Scholar
  36. 36.
    Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA 2000; 284(13): 1670–6PubMedCrossRefGoogle Scholar
  37. 37.
    Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 1998–1999 to 2000–2001. JAMA 2003; 289(3): 305–12PubMedCrossRefGoogle Scholar
  38. 38.
    Fleming B, Clauser S, Jencks S. The Diabetes Quality Improvement Project: it’s not just for health plans anymore. Group Pract J 2000; 49(4): 26–9Google Scholar
  39. 39.
    Levetan C. Mastering diabetes at Medicare. Clinical Diabetes 2000; 18(2): 74–9Google Scholar
  40. 40.
    NCQA. Promoting quality through DPRP recognition. Diabetes physician recognition program 2003. Washington, DC: NCQA, 2003Google Scholar
  41. 41.
    McClain MR, Wennberg DE, Sherwin RW, et al. Trends in the diabetes quality improvement project measures in Maine from 1994–1999. Diabetes Care 2003; 26(3): 597–601PubMedCrossRefGoogle Scholar
  42. 42.
    North Idaho Health Network [online]. Available from URL: http://www.nihn.net/physicians. [Accessed 2004 Aug 3]
  43. 43.
    Lovelace Health Plan website [online]. Available from URL: http://www.love-lacehealthplan.com/index.html. [Accessed 2004 Aug 3]
  44. 44.
    Renders CM, Valk GD, Griffin SJ, et al. Interventions to improve the management of diabetes in primary care, outpatient, and community settings. Diabetes Care 2001; 24(10): 1821–33PubMedCrossRefGoogle Scholar
  45. 45.
    NCQA. The state of health care quality 2002. Industry trends and analysis. Washington, DC: NCQA, 2002Google Scholar
  46. 46.
    Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA 1998; 280(17): 1490–6PubMedCrossRefGoogle Scholar
  47. 47.
    Sadur CN, Moline N, Costa M, et al. Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care 1999; 22(12): 2011–7PubMedCrossRefGoogle Scholar
  48. 48.
    Menzin J, Langley-Hawthorne C, Friedman M, et al. Potential short-term economic benefits of improved glycemic control. Diabetes Care 2001; 24(1): 51–5PubMedCrossRefGoogle Scholar
  49. 49.
    Sidorov J, Shull R, Tomcavage J, et al. Does diabetes management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria. Diabetes Care 2002; 25: 684–9PubMedCrossRefGoogle Scholar
  50. 50.
    Aubert RE, Herman WH, Waters J, et al. Nurse case management to improve glycemic control in diabetes patients in a health maintenance organization: a randomized controlled trial. Ann Intern Med 1998; 129(8): 605–12PubMedGoogle Scholar
  51. 51.
    Rubin RJ, Dietrich KA, Hawk AD. Clinical and economic impact of implementing a comprehensive diabetes management program in managed care. J Clin Endocrinol Metab 1998; 83(8): 2635–42PubMedCrossRefGoogle Scholar
  52. 52.
    Sidorov J, Gabbay R, Harris R, et al. Disease management for diabetes mellitus: impact on hemoglobin A1c. Am J Manag Care 2000; 6(11): 1217–26PubMedGoogle Scholar
  53. 53.
    Suwattee P, Lynch JC, Pendergrass ML. Quality of care for diabetic patients in a large urban public hospital. Diabetes Care 2003; 26(3): 563–8PubMedCrossRefGoogle Scholar
  54. 54.
    Srinivasan M, Przybylski M, Swigonski N. The Oregon health plan, predictors of office-based diabetic quality of care. Diabetes Care 2001; 24(2): 262–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Fevzi Akinci
    • 1
    • 2
  • Joseph Coyne
    • 1
    • 2
    • 3
  • Bernard Healey
    • 4
  • Joni Minear
    • 5
  1. 1.Department of Health Policy and AdministrationWashington State UniversitySpokaneUSA
  2. 2.Center in International Health Services Research and PolicyWashington State UniversitySpokaneUSA
  3. 3.Bocconi UniversityMilanItaly
  4. 4.King’s CollegeWilkes-BarreUSA
  5. 5.Regence BlueShield of IdahoLewistonUSA

Personalised recommendations