Module 1: Background — Making the Case for Diabetes Care Quality Improvement

Diabetes Care Quality Improvement: A Workbook for State Action

Learning Objective

Upon completion of Module 1, the user(s) will be able to:

1. Assess the need for diabetes care quality improvement in the State. (This section will pull together information to help "make the case" for improvement in diabetes care by showing why diabetes should be a priority.)

1. Assess the need for diabetes care quality improvement in the State.

Review Module 1 of the Resource Guide.

a. Look at Figure 1.1. This figure shows the diabetes prevalence range diagnosed for every 100 adults in 1994 for a standard age distribution across the States and then again in 2002. For example, in 1994, in Oklahoma less than 4 percent of adults (age-adjusted) had been diagnosed with diabetes. In 2002, this prevalence was at 6 percent or greater. If you want to know the unadjusted (actual) diabetes prevalence for your State, look in Table 2.3 of the Resource Guide.

What was the percent range of age-standardized diabetes prevalence in your State for 1994? (Figure 1.1)
_____________
What was the percent range of age-standardized diabetes prevalence in your State for 2002? (Figure 1.1)
_____________
Has age-standardized diabetes prevalence increased in your State since 1994?
_____________
What was the actual diabetes prevalence (not adjusted to a standard age distribution) in your State for 2002?
_____________

(If the unadjusted rate for your State is greater than the adjusted rate, then your State has an older population than the Nation on average. If the converse is true, your State has a younger population. If the two rates are the same or very close, then the population of your State has an age distribution typical of the Nation.)

b. Module 1, The Importance of Diabetes provide evidence that improving quality in diabetes care should be a priority because of prevalence, complications, costs, and health care disparities in addition to the fact that diabetes interventions work and there is a good potential for return on your investment in diabetes care. What do you envision as your State's starting point? Would you want to aim to reduce prevalence among the entire population, or among vulnerable subgroups of the population? Would you want to promote diabetes prevention or improvement in diabetes treatment? Would you want to focus on early interventions for people with diabetes or on effective treatment of complications? Would you want to select 2, 3, or 4 priority areas to work on?

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

c. What other reasons might indicate a need for diabetes care quality improvement in your State?

d. What evidence from these pages would you use to convince potential partners that diabetes should be a priority?

e. Module 1, The NHQR and NHDR as Resources for State Leaders summarize gaps that exist with respect to recommended care for people with diabetes and the care actually received. A variety of factors such as age, race, gender, education, employment, health insurance, income, place of residence, and health status can influence these gaps. To find measures for some of these factors compared to other States, you can use the Kaiser Family Foundation Web site on State health facts (http://www.statehealthfacts.org/).

1. Who in your State might be vulnerable to gaps in diabetes care (for example, the elderly, the uninsured, minorities, etc.)?

2. Does your State have a higher proportion of these vulnerable groups than other States?

f. Go to Appendix F, of the Resource Guide. Find any measures for any conditions that are below average in your State. Read the measure carefully. If the measure reflects a positive outcome or process (e.g., percent of women age 40 and over who report they had a mammogram in the last year), then a minus (-) sign in the column for your State indicates that your State is significantly below the national average and even farther below the best performing States while a plus (+) sign indicates your State is significantly above the national average. If a higher value for the measure represents a negative outcome or process (e.g., median time to thrombolysis (use of a blood thinner) for a heart attack victim), then a plus sign indicates that your State is significantly above the national average and farther from the best performing States while a minus sign indicates your State is significantly below the national average. Write down any topic and measure that shows poor processes or outcomes for your State.

1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
4. _______________________________________________________________________________________________
5. _______________________________________________________________________________________________
6. _______________________________________________________________________________________________

g. What measures for diabetes are below average?

_________________________________________________________________

h. What other measures indicate that you may want to create a quality improvement program for a different condition?

i. Do you think your State needs diabetes care quality improvement?

____________________________

j. Why or why not? If not, would you select a different condition?

Page last reviewed August 2008

Internet Citation: Module 1: Background — Making the Case for Diabetes Care Quality Improvement: Diabetes Care Quality Improvement: A Workbook for State Action. August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/diabguide/diabwork/diabqworkmod1.html