Comparative measures improve diabetes care

Goal is to revamp diabetes management

Diabetes patients have a bright future ahead of them. Thanks to the Diabetes Quality Improvement Project (DQIP), they can look forward to a better standard of care, from annual eye exams to foot exams and hypertension control. The coalition of public and private health care agencies behind the DQIP is nearing completion of a sweeping set of diabetes measurement sets designed to change the way diabetes is managed from the level of health plans down to individual providers.

DQIP is a collaborative effort of the Baltimore-based Health Care Financing Administration (HCFA), which oversees Medicare; the American Diabetes Association (ADA) in Alexandria, VA; the Foundation for Accountability (FACCT) in Portland, OR; and the National Committee for Quality Assurance (NCQA) in Washington, DC. Announced in August 1997 by President Clinton, the project is meant to enable consumers, employers, health plans, and providers to better evaluate and improve the health care of patients with diabetes.

"I can’t think of another activity that will improve diabetes care as rapidly and as consistently as this measurement set will," says Richard Kahn, PhD, chief scientific and medical officer at ADA. "More than any other activity, device, or drug in 20 years, this [project] has huge potential to drive quality improvement in diabetes care."

Originally organized and almost completely funded by HCFA, the project began because of the growing awareness of the costs of diabetes, both personal and financial, as well as a recognition of the current poor state of diabetes management in the United States, Kahn says. "Obviously, diabetes is a chronic disease that affects millions of people," adds Barry Scholl, spokesman for NCQA. "The health care system incurs huge expenses caring for these people. And we are really severely lacking in good comparative measures that can be used to assess how providers and health plans are delivering care and service to those patients who have diabetes."

Currently, a committee consisting of health care professionals and academics nominated by the member organizations is hammering out the details of the measurements sets, which are expected to be released by June. Once the sets are in place, each organization will assume different roles in evaluating their use, Kahn says.

For example, one measure probably will concern the use of annual eye exams for patients with diabetes. The NCQA would ask the health plans it accredits to submit data on how many of its members with diabetes ever receive an annual eye exam. HCFA would ask providers who seek reimbursement from Medicare to publicly disclose the proportion of their patients who receive an exam. FACCT would recommend to business and consumer groups that they question physicians and health plans about their record with regard to eye exams. "And the ADA, in its Provider Recognition Program, would say to providers, ‘If you want to get recognized by the ADA, you’ve got to do an annual eye exam,’" Kahn says.

Scholl says that the DQIP dovetails closely with another major initiative now under way at the NCQA: the launching of its measurement advisory panels, whose goal is to identify and develop better measures for HEDIS.

"There are measurement advisory panels in such areas as women’s health, behavioral health, and cardiovascular disease," he says. "And diabetes is clearly an area in which we need better measures." He adds that the NCQA’s existing relationships with the ADA and HCFA also played a role in the association’s getting involved. "We’ve been looking for ways to work with FACCT as well, so the project really gelled quite nicely with a lot of other things we’re working on."

Scholl says that although it’s likely that some DQIP measurements will find their way into HEDIS, it’s not yet clear exactly how or which ones. "Because the measures can be applied across all levels of the health care system and not just at the health plan level, there’s a possibility that not all the measures would be suitable for inclusion in HEDIS," he says.

Pilot program gaining recognition

FACCT, which already has a measurement set in place for diabetes, has recently launched pilot projects with HCFA and the Office of Personnel Management, the federal employee benefits program, that would incorporate FACCT measures in their patient satisfaction efforts. FACCT’s inclusion in the DQIP stems in part from those projects, says Doug Davidson, director of communications at FACCT. "The main reason we got involved is that our diabetes measurement set had already gotten good recognition and good discussion among the folks who were looking at quality for diabetes care," he says.

Davidson adds that HCFA was particularly interested in bringing FACCT to the table because of its emphasis on consumer-centered outcomes. "We think in terms of quality measurement in general," he says. "It’s helpful to have a shared vision of what you’re trying to measure — what quality looks like. And if we can come to a shared vision of quality in all sorts of categories, including care for diabetes, we have a better chance of moving forward to actually improve care and improve the quality of information that’s available to patients so that they can make better decisions about care."

[For more information on the Diabetes Quality Improvement Project, contact: Doug Davidson, director of communications, Foundation for Accountability, 520 6th Ave SW, Suite 700, Portland, OR 97204. Telephone: (503) 223-2228. Richard Kahn, PhD, chief scientific and medical officer, American Diabetes Association, 1660 Duke St., Alexandria, VA 22314. Telephone: (703) 299-2065. Barry Scholl, spokesman, National Committee for Quality Assurance, 2000 L St., NW, Suite 5000, Washington, DC 20036. Telephone: (202) 955-5197.]