Improved care and outcomes among elderly medicare managed care beneficiaries with diabetes

To examine individual- and plan-level factors related to improved diabetes care and outcomes between 1999 and 2001 among elderly Medicare managed care beneficiaries with diabetes.

Retrospective analysis of Medicare and individual-level Health Plan and Employer Data Information Set data.

We merged Medicare demographic information with person-level data regarding 6 comprehensive diabetes care measures provided by the National Committee on Quality Assurance for Medicare managed care enrollees for 1999. Then we identified those beneficiaries for whom comprehensive diabetes care information was also reported in 2001, and determined the improvement for each measure. Data on persons not meeting the comprehensive diabetes care criteria in 1999 were analyzed to determine the factors associated with appropriate care and outcomes in 2001.

Of the 174 combinations of individual- or plan-level factors and comprehensive diabetes care measures, 167 showed significant improvements. Nonetheless, for most of the 6 comprehensive diabetes care measures, poor care occurred more frequently for black patients than for white patients, among individuals in for-profit versus not for profit plans, and among individuals in independent practice association plans compared with group and staff model plans. Among the beneficiaries whose healthcare failed to meet the comprehensive diabetes care guidelines in 1999, by 2001, care guidelines were met in approximately three fourths for hemoglobin A1c and low-density lipoprotein cholesterol testing, but in only one half for eye examinations, low-density lipoprotein cholesterol control, and nephropathy monitoring.

Between 1999 and 2001, care of elderly Medicare patients with diabetes improved, including among individuals who previously had not received appropriate care. However, more improvement is needed to achieve equality among members of all race groups and plan types.