TY - JOUR
T1 - Performance status of health care facilities changes with risk adjustment of HbA(1c)
AU - Zhang, Quanwu
AU - Safford, Monika
AU - Ottenweller, John
AU - Hawley, Gerald
AU - Repke, Denis
AU - Burgess, James F.
AU - Dhar, Sunil
AU - Cheng, Hsiaofen
AU - Natto, Herbert
AU - Pogach, Leonard M.
PY - 2000
Y1 - 2000
N2 - OBJECTIVE - To develop a risk adjustment method for HbA(1c) based solely on administrative data and to determine the extent to which risk-adjusted HbA(1c) changes the identification of high- or low-performing medical facilities. RESEARCH DESIGN AND METHODS - Through use of pharmacy records, 204,472 diabetic patients were identified for federal fiscal year 1996 (FY96). Complete information (HbA(1c) levels, demographic data, inpatient records, outpatient pharmacy utilization records) was available on 38,173 predominantly male patients from 48 Veterans Health Administration (VHA) medical facilities. Hierarchical mixed-effects models were used to estimate risk-adjusted unique facility-level HbA(1c). RESULTS - Predicted HbA(1c) demonstrated expected patterns for major factors known to influence glycemic control. Poorer glycemic control was seen in minorities and patients with greater disease severity, longer duration of disease (using treatment type or presence of amputation as surrogates), and more extensive comorbidity (measured by an adapted Charlson index). Better glycemic control was seen in Caucasians, older diabetic patients, and patients with higher outpatient utilization. The number of performance outliers was reduced as a result of risk adjustment. For mean HbA(1c) levels, 7 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. For high-risk HbA(1c) (>9.5%) rates, 12 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. CONCLUSIONS - Risk adjustment using only administrative data resulted in substantial changes in identification of high or low performers compared with non-risk-adjusted HbA(1c). Although our findings are exploratory, risk adjustment using administrative data may be a necessary and achievable step in quality assessment of diabetes care measured by rates of high-risk HbA(1c) (>9.5%).
AB - OBJECTIVE - To develop a risk adjustment method for HbA(1c) based solely on administrative data and to determine the extent to which risk-adjusted HbA(1c) changes the identification of high- or low-performing medical facilities. RESEARCH DESIGN AND METHODS - Through use of pharmacy records, 204,472 diabetic patients were identified for federal fiscal year 1996 (FY96). Complete information (HbA(1c) levels, demographic data, inpatient records, outpatient pharmacy utilization records) was available on 38,173 predominantly male patients from 48 Veterans Health Administration (VHA) medical facilities. Hierarchical mixed-effects models were used to estimate risk-adjusted unique facility-level HbA(1c). RESULTS - Predicted HbA(1c) demonstrated expected patterns for major factors known to influence glycemic control. Poorer glycemic control was seen in minorities and patients with greater disease severity, longer duration of disease (using treatment type or presence of amputation as surrogates), and more extensive comorbidity (measured by an adapted Charlson index). Better glycemic control was seen in Caucasians, older diabetic patients, and patients with higher outpatient utilization. The number of performance outliers was reduced as a result of risk adjustment. For mean HbA(1c) levels, 7 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. For high-risk HbA(1c) (>9.5%) rates, 12 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. CONCLUSIONS - Risk adjustment using only administrative data resulted in substantial changes in identification of high or low performers compared with non-risk-adjusted HbA(1c). Although our findings are exploratory, risk adjustment using administrative data may be a necessary and achievable step in quality assessment of diabetes care measured by rates of high-risk HbA(1c) (>9.5%).
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U2 - 10.2337/diacare.23.7.919
DO - 10.2337/diacare.23.7.919
M3 - Article
C2 - 10895841
AN - SCOPUS:0033942008
SN - 0149-5992
VL - 23
SP - 919
EP - 927
JO - Diabetes Care
JF - Diabetes Care
IS - 7
ER -