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A quality assurance assessment of standards of medical care for patients with type 2 diabetes mellitus at Lifecourse Internal Medicine Clinic

1 August 2002


Background Diabetes mellitus (DM) is a chronic illness that places a significant burden on the US health care system in terms of substantial complications and associated costs. As a result, the disease has become a primary target for management programs and adherence to clinical practice guidelines.

Methods A retrospective study was conducted to define and measure the quality of diabetes care delivered to type 2 diabetic patients by evaluating health care process measures. The health care process measures assessed in this study were defined as adherence to current American Diabetic Association (ADA) standards of diabetes care and office practice standards. Two hundred forty-four type 2 diabetic patients identified using the International Classification of Diseases (ICD-9) code for type 2 DM at Lifecourse Internal Medicine Clinic in Farmington, New Mexico meeting inclusion criteria were included in the research study. A chart audit was performed using the clinic charts of all type 2 DM patients who have been enrolled continuously in the practice and diagnosed with type 2 DM for at least 12 months. The chart review included patient data between May 2000 and May 2002 to assess various diabetes quality indicators per standards of diabetes care established by the -ADA and Lifecourse Internal Medicine Clinic. Adherence to ADA and clinic office guidelines among all three providers at the internal medicine clinic was measured in ratio form and compared to pre-spedfied acceptable thresholds.

Results There were a number of quality indicators (per ADA guidelines and current office protocols) that were adhered to at least 70% of the guideline-specified time interval for the entire clinic including obtaining glycosolated hemoglobin, fasting lipid panel, and serum blood urea nitrogen/creatinine laboratory tests; seeing the patient for continuing care visits; and obtaining blood pressure and weight, reviewing home serum glucose tests, and providing diabetic education during continuing care visits. However, the sole quality indicator that met or exceeded the pre-specified adherence threshold for the clinic was diabetes education, which is to be provided at each continuing care visit. Recommendations and suggestions to enhance adherence to standards of diabetes care practices were developed based on the data obtained from the retrospective chart review.

Discussion/Conclusion Because diabetes literature has increasingly focused on the quality of diabetes care and its measurement, this study serves an important role in evaluating disease management practices and developing inferences with regard to the quality of DM care at Lifecourse Internal Medicine clinic. Extractions of the data may be applied and, thus, influence the practices of other providers and clinics providing care to Type 2 DM patients. 111


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