Improved diabetes care by primary care physicians: results of a group-randomized evaluation of the Medicare Health Care Quality Improvement Program (HCQIP)

Abstract 

Background and Objective

Glycosylated hemoglobin (HbA1C) measurements in patients with diabetes mellitus contribute to glycemic control, and, therefore to lower diabetic complication rates. Determine if an intervention that includes claims-based feedback about patterns of HbA1C measurement results in more frequent monitoring of HbA1C in diabetic Medicare beneficiaries.

Subjects

Primary care physicians in a single Southern state treating Medicare beneficiaries with diabetes mellitus.

Methods

A group-randomized evaluation of an intervention that included claims-based feedback about patterns of HbA1C measurement, educational materials, and practice aids.

Results

Rates for each quality indicator increased from 1996 to 1998 for both the intervention and comparison groups, although increases were larger for intervention counties. HbA1C testing rates increased in intervention counties 16.8% compared to 13.0% in the comparison counties, an absolute difference of 4.0% (95% CI, 0.7 to 7.3). Differences for other indicators were small, although positive and favoring the intervention, and lacked statistical significance.

Conclusions

Physician interventions that included practice-level feedback about monitoring of glycemic control successfully led to improved care of diabetic Medicare beneficiaries.

Keywords:  Diabetes mellitus, Randomized group trial, Quality improvement, Hemoglobin A1c, Clinical practice guidelines