Applying the Diabetes Quality Improvement Project Indicators in the Indian Health Service Primary Care Setting

Applying the Diabetes Quality Improvement Project Indicators in the Indian Health Service Primary Care Setting Kelly J. Acton , MD, MPH , Ray Shields , MD , Stephen Rith-Najarian , MD , Bernadine Tolbert , MD , Jane Kelly , MD , Kelly Moore , MD , Lorraine Valdez , RN, CDE , Betty Skipper , PHD and Dorothy Gohdes , MD From the Indian Health Service National Diabetes Program (K.J.A., L.V.), Albuquerque, New Mexico; the Portland Area Diabetes Program (R.S.), Bellingham, Washington; the Northern Minnesota Diabetes Center (S.R.-N.), Cass Lake, Minnesota; the Oklahoma Area Indian Health Service (B.T.), Oklahoma City, Oklahoma; the Alaska Native Medical Center (J.K.), Anchorage, Alaska; the Billings Area Indian Health Service (K.M.), Billings, Montana; and the Department of Family and Community Medicine (B.S.), University of New Mexico, Albuquerque, New Mexico. Address correspondence and reprint requests to Kelly J. Acton, MD, MPH, Indian Health Service National Diabetes Program, 5300 Homestead Rd., N.E., Albuquerque, NM 87110. E-mail: kelly.acton{at}mail.ihs.gov . Abstract OBJECTIVE — With publication of the Diabetes Quality Improvement Project (DQIP) measures, the Indian Health Service National Diabetes Program applied the DQIP format to its IHS Diabetes Care and Outcomes Audit for comparison and benchmarks. RESEARCH DESIGN AND METHODS — Since 1986 the IHS Diabetes Care and Outcomes Audit has been conducted by medical record review in >75% of IHS and tribal facilities. Each year systematic random sample of charts is drawn from local diabetes registries. Chart reviews are conducted by trained professionals according to standard definitions and instructions. Abstracted data are entered into a microcomputer-based epidemiologic software package. Local, regional, and national rates are constructed for each item. During the period 1995-1997, 150 facilities submitted data for compilation, representing participation from all 12 IHS administrative regions. The IHS Diabetes Care and Outcomes Audit collected virtually all of the DQIP measures, with the exception of LDL cholesterol (which was added to the record review in 1998). RESULTS — In 1995, 1996, and 1997, a total of 9,557, 9,985, and 9,626 individuals, respectively, were included in the total IHS audit sample. The reviews for 1995, 1996, and 1997 revealed that of all subjects: 55, 65, and 80%, respectively, had more than one HbA 1c test during the year ( P < 0.001); 42, 38, and 34%, respectively, had a high-risk H