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Published on: June 11, 2012
Patient complexity in quality comparisons for glycemic control: an observational study
Monika M Safford1, Michael Brimacombe, Quanwu Zhang
1Deep South Center on Effectiveness at Birmingham VA Medical Center and University of Alabama at Birmingham, Birmingham, AL, USA. msafford@uab.edu
Implementation Science : IS
|January 8, 2009
Summary
Quality comparisons for glycemic control using hemoglobin A1c (HbA1c) are flawed. Adjusting HbA1c for patient complexity significantly alters performance rankings, suggesting current measures may misidentify quality issues.
Area of Science:
- Health Services Research
- Clinical Quality Measurement
- Diabetes Management
Background:
- Current quality of care comparisons for glycemic control do not account for patient complexity.
- This study addresses the need to incorporate patient-level factors into healthcare performance evaluations.
Purpose of the Study:
- To develop and validate a method for adjusting hemoglobin A1c (HbA1c) levels based on patient complexity.
- To examine how adjusting HbA1c values for complexity impacts quality comparisons among healthcare providers.
Main Methods:
- A cross-sectional study utilized national US Department of Veterans Affairs data from 1999.
- Individual HbA1c levels were adjusted for age, social support, comorbidities, and disease severity (insulin use).
- Performance measures and medical center ranks were compared using adjusted versus unadjusted HbA1c values across multiple glycemic control thresholds.
Main Results:
- The adjustment model explained 8.3% of the variance in HbA1c levels.
- Adjusting for patient complexity led to substantial rank changes, particularly for top and bottom-performing centers.
- These rank shifts were consistent across various HbA1c thresholds (8.0% to 9.5%).
Conclusions:
- Adjusting glycemic control measures for patient complexity significantly alters the identification of high and low-performing healthcare providers.
- Existing performance measures may inaccurately reflect quality issues in diabetes care.
- Linking financial reimbursements to unadjusted quality metrics may negatively impact the care of complex patient populations.
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