Diabetes care quality in the veterans affairs health care system and commercial managed care: The TRIAD study

Eve A. Kerr, Robert B. Gerzoff, Sarah L. Krein, Joseph V. Selby, John D. Piette, J. David Curb, William H. Herman, David Marrero, K. M Venkat Narayan, Monika M. Safford, Theodore Thompson, Carol M. Mangione

Research output: Contribution to journalArticle

229 Citations (Scopus)

Abstract

Background: No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions. Objective: To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods. Design: Cross-sectional patient survey with retrospective review of medical records. Setting: 5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions. Participants: 8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care. Measurements: We compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics. Results: Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin A 1c; P = 0.006; 91% vs. 75% for annual eye examination; P <0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure <140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin A1c (for example, 86% vs. 72% for low-density lipoprotein cholesterol level <3.37 mmol/L [

Original languageEnglish (US)
Pages (from-to)272-281+I
JournalAnnals of Internal Medicine
Volume141
Issue number4
StatePublished - Aug 17 2004
Externally publishedYes

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Veterans Health
Quality of Health Care
Managed Care Programs
Veterans
Delivery of Health Care
Organizations
LDL Cholesterol
Blood Pressure
Hemoglobin A
Process Assessment (Health Care)
Medical Records
Hemoglobins
Outpatients
Cross-Sectional Studies
Demography
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kerr, E. A., Gerzoff, R. B., Krein, S. L., Selby, J. V., Piette, J. D., Curb, J. D., ... Mangione, C. M. (2004). Diabetes care quality in the veterans affairs health care system and commercial managed care: The TRIAD study. Annals of Internal Medicine, 141(4), 272-281+I.

Diabetes care quality in the veterans affairs health care system and commercial managed care : The TRIAD study. / Kerr, Eve A.; Gerzoff, Robert B.; Krein, Sarah L.; Selby, Joseph V.; Piette, John D.; Curb, J. David; Herman, William H.; Marrero, David; Narayan, K. M Venkat; Safford, Monika M.; Thompson, Theodore; Mangione, Carol M.

In: Annals of Internal Medicine, Vol. 141, No. 4, 17.08.2004, p. 272-281+I.

Research output: Contribution to journalArticle

Kerr, EA, Gerzoff, RB, Krein, SL, Selby, JV, Piette, JD, Curb, JD, Herman, WH, Marrero, D, Narayan, KMV, Safford, MM, Thompson, T & Mangione, CM 2004, 'Diabetes care quality in the veterans affairs health care system and commercial managed care: The TRIAD study', Annals of Internal Medicine, vol. 141, no. 4, pp. 272-281+I.
Kerr EA, Gerzoff RB, Krein SL, Selby JV, Piette JD, Curb JD et al. Diabetes care quality in the veterans affairs health care system and commercial managed care: The TRIAD study. Annals of Internal Medicine. 2004 Aug 17;141(4):272-281+I.
Kerr, Eve A. ; Gerzoff, Robert B. ; Krein, Sarah L. ; Selby, Joseph V. ; Piette, John D. ; Curb, J. David ; Herman, William H. ; Marrero, David ; Narayan, K. M Venkat ; Safford, Monika M. ; Thompson, Theodore ; Mangione, Carol M. / Diabetes care quality in the veterans affairs health care system and commercial managed care : The TRIAD study. In: Annals of Internal Medicine. 2004 ; Vol. 141, No. 4. pp. 272-281+I.
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