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Effect of Quality Improvement on Racial Disparities in Diabetes Care
Thomas D. Sequist, MD, MPH;
Alyce Adams, PhD;
Fang Zhang, MS;
Dennis Ross-Degnan, ScD;
John Z. Ayanian, MD, MPP
Arch Intern Med. 2006;166:675-681.
Background Racial disparities in care are well documented; information regarding solutions is limited. We evaluated whether generic quality improvement efforts were associated with changes in racial disparities in diabetes care.
Methods Using insurance claims and electronic medical record data, we identified 5101 whites and 1987 blacks with diabetes mellitus receiving care within a multispecialty group practice from 1997 to 2001. We assessed rates of annual low-density lipoprotein cholesterol level testing, low-density lipoprotein cholesterol level control (<130 mg/dL [<3.37 mmol/L]), statin therapy, annual glycosylated hemoglobin level testing, glycosylated hemoglobin level control (<7.0%), and annual dilated eye examinations. We used logistic regression models with generalized estimating equations to adjust for race, year, race x year interactions, age, and sex.
Results Rates of annual low-density lipoprotein cholesterol level testing increased from 39% to 64%, while the white-black disparity decreased from 14% to 4%; rates of low-density lipoprotein cholesterol level control increased from 15% to 43%, while the white-black disparity decreased from 9% to 6% (P<.001 for both race x year interactions). Statin therapy rates increased from 20% to 37%; however, black patients remained less likely than white patients to receive therapy. The 1997 rates of annual glycosylated hemoglobin level testing (76%) and annual eye examinations (74%) were high, and there was no white-black disparity over time. Rates of glycosylated hemoglobin level control remained low (31%), and the white-black disparity remained constant at 10%.
Conclusions Racial disparities were diminished in some aspects of diabetes care following variably successful quality improvement, but differences in the use of statins and glycemic level control persisted. Reducing disparities may require a focus on minority health.
Author Affiliations: Departments of Health Care Policy (Drs Sequist and Ayanian) and Ambulatory Care and Prevention (Drs Adams and Ross-Degnan and Mr Zhang), Harvard Medical School; Division of General Medicine and Primary Care, Brigham and Women's Hospital (Drs Sequist and Ayanian); Harvard Vanguard Medical Associates (Dr Sequist); and Harvard Pilgrim Health Care (Drs Adams and Ross-Degnan and Mr Zhang); Boston, Mass.
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