Doctors Get Rated On Their
Diabetes Care
Five hundred primary care doctors will be
graded on their diabetes care for their
patients.
Nearly 500 Kansas City area primary-care
doctors soon will find out how conscientious
they have been in providing this kind of medical
attention to their adult diabetes patients —
and in many cases, the news will not be good.
Thousands of patients have not been getting
all the tests and screenings they need, new data
show. This news will come in diabetes care
"report cards" that doctors are
getting in the mail. The confidential reports
will show each doctor how many of his or her
diabetes patients received four crucial tests in
2002 and how that compared with the overall
level of testing provided by area doctors.
The local initiative is part of a national
trend to provide doctors with ways to compare
their care with that provided by the rest of the
medical community.
The report cards are the work of the Kansas
City Quality Improvement Consortium. The
organization was created in 2000 by local
medical societies, insurance companies and
medical schools. In 2002 the consortium provided
doctors with guidelines for treating common
ailments, including diabetes, depression, asthma
and heart failure. After evaluating this first
report card on diabetes, the consortium plans to
issue more report cards annually.
"This has tremendous importance,"
said Nathaniel Clark, a physician and national
vice president of the American Diabetes
Association. "The only way physicians can
know if they're providing quality care is to
measure that care and give the data back to
them."
As Americans grow increasingly overweight,
the prevalence of diabetes has increased at
alarming rates. About 18 million adults now have
the disease.
The report cards will show what percentage of
diabetes patients in each physician practice
received the monitoring tests that experts
consider essential for diabetes control. These
tests need to be done annually or more
frequently:
• A blood test, called hemoglobin A1c,
that shows long-term blood-sugar levels.
• A blood test measuring levels of LDL
cholesterol, the "bad" cholesterol
that clogs arteries.
• An eye exam to look for damage to
the retina.
• A urine test to catch early signs of
kidney damage.
"These tests are extremely critical.
They can end up sparing a person his eyes and
his kidneys," Clark said. "But we have
study after study showing that a distressingly
small percentage of patients are getting the
care they need."
Of the 8,937 patients covered by the Kansas
City report cards, 77 percent received the
blood-sugar and cholesterol tests, 43 percent
received the test for kidney damage and 35
percent received the eye exams in 2002.
The blood-sugar levels of 39 percent of the
patients were poorly controlled. The data showed
that cholesterol levels were controlled in 61
percent of patients.
As proof that doctors can do better, Laiben
pointed to data the report cards include on the
physicians who got top rankings from the
consortium, whose practices account for 10
percent of the diabetes patients. More than 90
percent of these patients had received the
needed blood tests. Only 7 percent of the
patients had poorly controlled blood-sugar
levels.
"Other things get focused on during the
visit. You may be addressing their blood
pressure or a pain problem. Something else takes
precedence."
Local initiatives like the Kansas City
Quality Improvement Consortium are becoming more
common, said Brian Schilling, spokesman for the
National Committee for Quality Assurance, the
organization that accredits managed-care health
plans and set the diabetes standards used in the
report cards.
"One of the biggest stumbling blocks is
getting physician support," Schilling said.
"When they hear a physician evaluation is
coming their way, it may not be welcomed."
Stephen Salanski, a consortium member and
family physician in Kansas City, expects local
doctors to be more receptive toward the report
cards because doctors played a major role in
developing them.
"The hope is they'll see this as a
tool," he said. "Most doctors don't
want to be just average on this data. They want
to be in the top 10 percent."
