There were significant differences between the DIABETES, RESIDENT, and FACULTY clinics. The quality-of-Care for patients receiving medical treatment in three practice settings of the same hospital were compared.
Records were abstracted from three practice settings: the Diabetes Clinic (DIABETES), a general medicine clinic staffed by internal medicine residents (RESIDENT), and a general medicine clinic whose providers were medical school faculty physicians (FACULTY). Record review (n = 791) yielded data on diabetes indicators that were derived primarily from the Diabetes Quality Improvement Project.
There were significant differences between the DIABETES, RESIDENT, and FACULTY clinics for the percentages of patients with HbA1c testing, nephropathy assessment, lipid assessment, LDL, blood pressure, eye examinations, foot examinations , ACE inhibitor treatment and aspirin treatment .
In summary, we have shown that patients treated in three different practice settings in a large urban public hospital differ significantly in their adherence with diabetes practice guidelines. Indicators in all clinics were suboptimal, despite the fact that patients were seen at a relatively slow pace (one to two patients per hour), compared with many health plans. The fact that indicators in the Diabetes Clinic compare favorably with published data for funded patients supports the proposition that medical indigency does not necessarily preclude diabetes management according to industry standards.
Large hospital systems must take the practice setting into account when assessing the quality of diabetes care that is provided. We consider the results achieved by the Diabetes Clinic to be minimal attainable goals for all patients receiving care in our hospital. Based on the results of this study, we have implemented pilot programs that specifically target areas with low levels of adherence to diabetes practice guidelines. Diabetes Care 26:563-568, 2003