Dataset Information

Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment?

ABSTRACT:

Objective

To evaluate facility rankings in achieving <7% A1C levels based on the complexity of glycemic treatment regimens using threshold and continuous measures.

Research design and methods

We conducted a retrospective administrative data analysis of Veterans Health Administration Medical Centers in 2003-2004. Eligible patients were identified using National Committee for Quality Assurance (NCQA) measure specifications. A complex glycemic regimen (CGR) was defined as receipt of insulin or three oral agents. Facilities were ranked using five ordinal categories based up both z score distribution and statistical significance (P < 0.05). Rankings using the NCQA definition were compared with a subset receiving CGRs using both a <7% threshold and a continuous measure awarding proportional credit for values between 7.9 and <7.0%. Ranking correlation was assessed using the Spearman correlation coefficient.

Results

A total of 203,302 patients (mean age 55.2 years) were identified from 127 facilities (range 480-5,411, mean 1,601); 26.7% (17.9-35.2%) were receiving CGRs, including 22.0% receiving insulin. Mean A1C and percent achieving A1C <7% were 7.48 and 48% overall and 8.32 and 24.8% for those receiving CGRs using the threshold measure; proportion achieved was 60.1 and 37.2%, respectively, using the continuous measure. Rank correlation between the overall and CGR subset was 0.61; 8 of 24 of the highest or lowest ranked facilities changed to nonsignificance status; an additional five sites changed rankings.

Conclusions

Facility rankings in achieving the NCQA <7% measure as specified differ markedly from rankings using the CGR subset. Measurement for public reporting or payment should stratify rankings by CGR. A continuous measure may better align incentives with treatment intensity.

SUBMITTER: Pogach LM

PROVIDER: S-EPMC2945148 | biostudies-literature | 2010 Oct

REPOSITORIES: biostudies-literature

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Publications

Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment?

Pogach Leonard M LM Rajan Mangala M Maney Miriam M Tseng Chin-Lin CL Aron David C DC

Diabetes care 20100709 10

<h4>Objective</h4>To evaluate facility rankings in achieving <7% A1C levels based on the complexity of glycemic treatment regimens using threshold and continuous measures.<h4>Research design and methods</h4>We conducted a retrospective administrative data analysis of Veterans Health Administration Medical Centers in 2003-2004. Eligible patients were identified using National Committee for Quality Assurance (NCQA) measure specifications. A complex glycemic regimen (CGR) was defined as receipt of ...[more]

PMID: 20622158

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Dataset Information

Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment?

Objective

Research design and methods

Results

Conclusions

Publications

Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment?

Similar Datasets

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