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dc.contributor.authorBerlowitz, Dan R.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorGlickman, Mark
dc.contributor.authorFriedman, Robert H.
dc.contributor.authorPogach, Leonard M.
dc.contributor.authorNelson, Audrey L.
dc.contributor.authorWong, Ashley T.
dc.date2022-08-11T08:10:42.000
dc.date.accessioned2022-08-23T17:17:19Z
dc.date.available2022-08-23T17:17:19Z
dc.date.issued2005-12-13
dc.date.submitted2010-07-01
dc.identifier.citationHealth Serv Res. 2005 Dec;40(6 Pt 1):1836-53. <a href="http://dx.doi.org/10.1111/j.1475-6773.2005.00436.x">Link to article on publisher's site</a>
dc.identifier.issn0017-9124 (Linking)
dc.identifier.doi10.1111/j.1475-6773.2005.00436.x
dc.identifier.pmid16336551
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47602
dc.description.abstractOBJECTIVE: To develop a valid quality measure that captures clinical inertia, the failure to initiate or intensify therapy in response to medical need, in diabetes care and to link this process measure with outcomes of glycemic control. DATA SOURCES: Existing databases from 13 Department of Veterans Affairs hospitals between 1997 and 1999. STUDY DESIGN: Laboratory results, medications, and diagnoses were collected on 23,291 patients with diabetes. We modeled the decision to increase antiglycemic medications at individual visits. We then aggregated all visits for individual patients and calculated a treatment intensity score by comparing the observed number of increases to that expected based on our model. The association between treatment intensity and two measures of glycemic control, change in HbA1c during the observation period, and whether the outcome glycosylated hemoglobin (HbA1c) was greater than 8 percent, was then examined. PRINCIPAL FINDINGS: Increases in antiglycemic medications occurred at only 9.8 percent of visits despite 39 percent of patients having an initial HbA1c level greater than 8 percent. A clinically credible model predicting increase in therapy was developed with the principal predictor being a recent HbA1c greater than 8 percent. There were considerable differences in the intensity of therapy received by patients. Those patients receiving more intensive therapy had greater improvements in control (p < .001). CONCLUSIONS: Clinical inertia can be measured in diabetes care and this process measure is linked to patient outcomes of glycemic control. This measure may be useful in efforts to improve clinicians management of patients with diabetes.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=16336551&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1111/j.1475-6773.2005.00436.x
dc.subjectAged
dc.subjectComorbidity
dc.subjectDiabetes Complications
dc.subjectDiabetes Mellitus
dc.subjectDrug Utilization
dc.subjectFemale
dc.subjectHemoglobin A, Glycosylated
dc.subjectHumans
dc.subjectHypoglycemic Agents
dc.subjectInsulin
dc.subjectMale
dc.subjectOutcome Assessment (Health Care)
dc.subject*Quality Indicators, Health Care
dc.subjectRisk Factors
dc.subjectSeverity of Illness Index
dc.subjectUnited States
dc.subjectUnited States Department of Veterans Affairs
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleDeveloping a quality measure for clinical inertia in diabetes care
dc.typeJournal Article
dc.source.journaltitleHealth services research
dc.source.volume40
dc.source.issue6 Pt 1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/730
dc.identifier.contextkey1378877
html.description.abstract<p>OBJECTIVE: To develop a valid quality measure that captures clinical inertia, the failure to initiate or intensify therapy in response to medical need, in diabetes care and to link this process measure with outcomes of glycemic control.</p> <p>DATA SOURCES: Existing databases from 13 Department of Veterans Affairs hospitals between 1997 and 1999.</p> <p>STUDY DESIGN: Laboratory results, medications, and diagnoses were collected on 23,291 patients with diabetes. We modeled the decision to increase antiglycemic medications at individual visits. We then aggregated all visits for individual patients and calculated a treatment intensity score by comparing the observed number of increases to that expected based on our model. The association between treatment intensity and two measures of glycemic control, change in HbA1c during the observation period, and whether the outcome glycosylated hemoglobin (HbA1c) was greater than 8 percent, was then examined.</p> <p>PRINCIPAL FINDINGS: Increases in antiglycemic medications occurred at only 9.8 percent of visits despite 39 percent of patients having an initial HbA1c level greater than 8 percent. A clinically credible model predicting increase in therapy was developed with the principal predictor being a recent HbA1c greater than 8 percent. There were considerable differences in the intensity of therapy received by patients. Those patients receiving more intensive therapy had greater improvements in control (p < .001).</p> <p>CONCLUSIONS: Clinical inertia can be measured in diabetes care and this process measure is linked to patient outcomes of glycemic control. This measure may be useful in efforts to improve clinicians management of patients with diabetes.</p>
dc.identifier.submissionpathqhs_pp/730
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages1836-53


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