Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients

Elbert S. Huang, Greg Sachs, Marshall H. Chin

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Current approaches to assessing quality of diabetes care do not account for the heterogeneity of older patients. Objective: We sought to compare conclusions regarding adequacy of glucose and blood pressure control using current quality assessment approaches and a stratified approach based on geriatric care guidelines. Design: This was a cross-sectional evaluation of diabetes care. Subjects: We studied patients older than 65, living with diabetes (n = 554) attending clinics of an academic medical center. Measurements: We measured the proportion of patients with and without markers of poor health (life expectancy ≤5 years, age ≥85, 4-6 activities of daily living dependencies, or Charlson Comorbidity Index Score ≥5) achieving treatment goals. Results: Under general population goals (glycosylated hemoglobin [HbA1C] ≤6.5% or 1C ≤ 8%, SBP <140 mm Hg) would be applied to patients with diminished health, with general population goals reserved for healthier patients. With this stratified approach, the proportion of sicker patients achieving their specified glucose (61-83%) and SBP goals (37-64%) generally was high, depending on the criteria for poor health, whereas the proportion of healthier patients achieving their goals remained low. Conclusions: A stratified approach to assessing the quality of diabetes care leads to distinct care conclusions for older patients with and without markers of diminished health. An approach to quality assessment and quality improvement that acknowledges patient heterogeneity could help ensure the clinical relevance of such efforts for older patients.

Original languageEnglish (US)
Pages (from-to)373-377
Number of pages5
JournalMedical Care
Volume44
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Fingerprint

Quality of Health Care
geriatrics
Geriatrics
chronic illness
Guidelines
health
Health
comorbidity
life expectancy
Glucose
Glycosylated Hemoglobin A
Activities of Daily Living
Quality Improvement
Life Expectancy
evaluation
Population
Comorbidity
Blood Pressure

Keywords

  • Diabetes mellitus
  • Geriatrics
  • Practice guidelines
  • Quality of care

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients. / Huang, Elbert S.; Sachs, Greg; Chin, Marshall H.

In: Medical Care, Vol. 44, No. 4, 04.2006, p. 373-377.

Research output: Contribution to journalArticle

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