Veterans Affairs patients with diabetes are better cared for than managed care patients

Researchers have found that Veterans Affairs patients with diabetes are more likely to receive recommended tests and have better outcomes than managed care patients.

1,285 patients with diabetes from five VA medical centers and 6,920 patients in eight commercial managed care health plans were studied. The researchers compared the frequency of standard processes of care, such as recommended tests, and their outcomes related to diabetes control.

Overall VA patients received more appropriate care, and in many cases the differences in the quality of care were extreme.

The researchers looked at whether the patients received seven standard procedures were conducted:

• eye exam,
• hemoglobin A1c test (a measure of glucose control),
• cholesterol screening,
• foot exam,
• urine analysis,
• counseling on aspirin use
• a flu vaccine.

Researchers also checked whether patients fell within acceptable limits for blood pressure, cholesterol and hemoglobin A1c. The team found VA patients were more likely to receive each recommended screening or service:

• 93 percent of VA patients had an annual hemoglobin A1c test, compared to 83 percent of managed care patients;
• 75 percent of VA patients were counseled about aspirin use, compared to 49 percent of managed care patients;
• 91 percent of VA patients had an annual eye exam, compared to 75 percent of managed care patients;
• 98 percent of VA patients had an annual foot exam, compared to 84 percent of managed care patients.

VA patients also had their hemoglobin A1c and LDL cholesterol levels in better check. Blood pressure control was comparable for both sets of patients, with just over half having blood pressure levels 140/90 and even fewer below the stricter recommended levels.

Beginning in 1995, the VA instituted a series of quality improvements focused on managing chronic diseases, including diabetes. Many of the changes reflected recommendations subsequently promoted by the Institute of Medicine and treatment standards already used by some managed care organizations, such as performance monitoring, electronic medical records, disease management programs, patient reminders and automated feedback to doctors on quality of care.

"These results are encouraging because they demonstrate that optimizing how care is delivered can translate into clinical benefits for patients. However, we still need to learn more about which of the many changes the VA instituted improve quality the most, so that managed care health plans can implement these in the most cost effective manner," says senior author Carol M. Mangione, M.D., M.S.P.H., professor of medicine at the David Geffen School of Medicine at UCLA.

More than 18 million Americans have diabetes, a group of serious diseases characterized by high blood sugar levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease and amputations. It is the fifth leading cause of death by disease in the U.S.

http://www.med.umich.edu/