Close Window| Close Window |
 |
|
|
VHA/DOD Guideline for
Management of Patients with
DIABETES MELLITUS: Modules E, F, G, H, (5 indicators) DIABETES MELLITUS: Rationale & References: "Diabetes is a serious disease that affects over 16 million Americans, and over 150,000 people die each year because of it. It strikes individuals of all ages and socioeconomic groups, and individuals of African, Asian, and American Indian descent are particularly vulnerable. The annual cost of diabetes has been reported to be nearly 100 billion dollars and thus it ranks as one of the deadliest and most costly diseases known to mankind. Most of the morbidity and mortality of diabetes is due to the complications associated with the disease: blindness, kidney failure, nerve damage, and cardiovascular disease. Diabetic retinopathy is the leading cause of new blindness in people under 65; diabetic nephropathy is the leading cause of end stage renal disease (kidney failure) in the United States; neuropathy results in the second leading cause of lower extremity amputation with over 50,000 Americans annually losing a limb because of diabetes; diabetic macrovascular disease leads to accelerated coronary heart disease and peripheral vascular disease, both of which result in premature death. Studies show that many, if not all, of the complications of diabetes can be slowed or even prevented by better management on the part of the health care team and the patient. Improved blood glucose control, and regular eye and foot examinations are but three of the practices that have been unequivocally shown to reduce complications and thereby diminish the heavy personal and financial toll attributed to diabetes." As stated in Diabetes Quality Improvement Project Background http://www.diabetes.org/main/community/info_news/news/dqip.jsp DM is one of the most prevalent and costly chronic diseases in our population. Many vascular eye morbidities can be prevented or maintained if detected and addressed early. In the private sector nationwide, about 44% (of 16 million total individuals with diabetes) receive appropriate annual eye exams. It is predicted, if the rate were increased to 66.4% (90th percentile) an additional 2 million would be screened. Out of that increase, 3,400 fewer people would go blind each year. (State of Managed Care Quality Report 2000, NCQA, pg. 38) Resources:
Patient Cohort: Primary Care CPG – DM: Eye (1) Indicator: Numerator: Eligible DM patients with Retinal Exam by an Eye Care Specialist, within specified time periods Denominator: Eligible Patients with Diabetes Mellitus Definitions & Methodology:
CPG – DM: Foot Exam Sensory (1) Rationale & References: VHA/DoD Guidelines for Management of Patients with Diabetes Mellitus: Module F Resources: Guideline and link to results can be seen at: www.oqp.med.va.gov/cpg/cpg.htm Indicator: Percent of DM patients having annual sensory foot exam Numerators: Eligible Patients with Diabetes Mellitus receiving sensory exam annually Denominator: All eligible Patients with Diabetes sampled Definitions & Methodology:
CPG – DM: Glycemic Control (2) A. CPG – DM: Hemoglobin A1C < 9.0 B. CPG – DM: Hemoglobin A1C > 11.0 or not done Rationale & References: VHA/DoD Guidelines for Management of Patients with Diabetes Mellitus: Module G Resources: Guideline and link to results can be seen at: www.oqp.med.va.gov/cpg/cpg.htm Indicator Statements: a. Percent of patients with DM having HgbA1c less than 9.0 b. Percent of patients with DM having HgbA1c > 11 or not done Numerators: a. Eligible patients with Diabetes Mellitus having hemoglobin A1c <9.0 b. Eligible patients with Diabetes Mellitus having hemoglobin A1c >11
Denominator: Eligible Diabetic Patients in sample, including those who have not have a HgbA1c done in the past 12 months. Definitions & Methodology:
Note: The question pertaining to level of glycemic control pertains to ALL diabetic patients, not just those who have had the test done. Therefore, if no HgbA1c was done, the patient is included in the denominator for both indicators and the numerator for assumed to be out of control (e.g. >11). For example, indicator a. is NOT ‘of those that had a HgbA1c done, how many were < 9.0’, but is ‘of ALL of all DM pts in the sample, how many had HbgA1c < 9.0. Rationale & References: VHA/DoD Guidelines for Management of Patients with Diabetes Mellitus: Module H Resources: Guideline and link to results can be seen at: www.oqp.med.va.gov/cpg/cpg.htm Indicators: Percent of eligible patients with Diabetes Mellitus with blood pressure: a. Less than 140/90 b. Greater than or equal to 160/100 or No B/P recorded in past year Numerators: a. Eligible Patients with DM with blood pressure < 140/90 b. Eligible Patients with DM with blood pressure > 160/100 or not BP in past year Denominator: Eligible Patients with Diabetes Mellitus Definitions & Methodology:
Note: If no blood pressure was recorded during the past year, the result is assumed to be out of control. Patient included in the denominator of both a. and b. and in the numerator of b. counts against the facility in both cases. Goals and Comparisons Diabetes CPG DM Eye Exam VHA Average FY2001: 66% Network Range: 55%-76% FY2001 Best Scoring Networks (2)
Medical Centers (2)
Non-VA Comparison DM Eye Exam HEDIS 2001 Report (NCQA, patient care in 2000) average: 48% HCQIP MEDIAN 68.8% HCFA (1998-99): 68.5% Average Healthy People 2010: 75% by CY 2010 FY2002 DM Eye indicator component target: Fully Successful: 70% Exceptional: 76%
DM Foot Sensory Exam VHA Average FY2001: 78% Network Range 62% - 83% FY2001 Best Scoring for Foot Sensory Exam Networks (2)
Medical Centers (2)
Non-VA Comparison not available Foot sensory exam indicator component target: Fully Successful: 82% Exceptional: 87%
DM Glycemic Control a. HgbA1C < 9.0
b. HgbA1C >11 or not done
DM HTN a. DM HTN BP < 140/90
b. DM HTN > 160/100 (lower score is better)
|