An instrumental variable analysis of the impact of practice guidelines on improving quality of care and diabetes-related outcomes in the elderly Medicare population.
Li-S; Liu-L; Gilbertson-D; McBean-M; Dowd-B; Collins-A
Am J Med Qual 2008 May; 23(3):222-230
The effect of the diabetes practice guideline recommending =2 HbA1c tests annually on diabetes-related outcomes was evaluated using Medicare claims data. The study population included 1998 and 1999 incident diabetes patients aged = 67 years, who were Medicare eligible and without known diabetes-related complications at baseline. Number of HbA1c tests was measured 1 year after diabetes incidence. All-cause death and diabetes complications were identified during follow-up, through December 2003. The analysis was conducted with an instrumental variable method and a bivariate probit model, controlling for individual, social, and health care system characteristics. Among 13,033 patients, 27.1% followed the practice guideline. Receiving =2 HbA1c tests annually was significantly associated with a decrease in probability of 28.8 percentage points for macrovascular complications, 28.7 for atherosclerotic heart disease, and 23.1 for chronic kidney disease or end-stage renal disease in the 4-year follow-up period.
Age-factors; Age-groups; Biological-function; Biological-systems; Disease-incidence; Epidemiology; Exposure-assessment; Exposure-levels; Exposure-methods; Health-care; Health-programs; Health-services; Health-standards; Health-surveys; Injury-prevention; Mathematical-models; Medical-care; Medical-monitoring; Medical-screening; Medical-services; Medical-treatment; Quantitative-analysis; Risk-analysis; Safety-education; Safety-measures; Safety-practices; Statistical-analysis; Standards;
Author Keywords: diabetes; diabetes education program; HbA1c
testing; instrumental variable; Medicare
Allan J. Collins, MD, United States Renal Data System, 914 South 8th St, Suite S-206, Minneapolis, MN 55404
American Journal of Medical Quality
University of Minnesota Twin Cities