Module 2: Data — Understanding the Foundation of Quality Improvement

Diabetes Care Quality Improvement: A Workbook for State Action

Learning Objectives

Upon completion of Module 2, the user(s) will be able to:

Understand the process and outcome measures for tracking the quality of diabetes care.(Understanding these measures will help the user identify gaps in recommended care, how closing these gaps can improve health status, and how the measures can be used as the basis for setting goals.)
Compare State data with national benchmarks and identify gaps in State data.(Collecting and analyzing data in your State is important to making your case for improving care and calculating the long-term costs of diabetes and its impact on your State. Data also help you create baseline measures and set goals for improvement.)
Develop an inventory of the data systems available at the State and local levels.(An inventory will identify existing data that may be useful and collection mechanisms that might easily be enhanced for tracking quality improvement.)
Use published studies to arrive at State or local estimates.(Research helps inform States of gaps in their data, questions that remain to be answered, and the need for additional research.)
Calculate the direct and indirect costs of diabetes for States and State Medicaid programs.(Knowing the costs will help make the case for quality improvement, provide States with baseline measures, and help set goals.)

1. Understand the process and outcome measures used for tracking the quality of diabetes care.

Read Module 2 and Figure 2.1 of the Resource Guide and answer the following questions:

a. What does HbA1c testing (a process measure) tell you about blood glucose levels (an outcome measure)?

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b. How would increasing HbA1c testing improve diabetes outcomes?

2. Compare State data with national benchmarks and identify gaps in State data.

Review Sources of NHQR Data on Diabetes Care of the Resource Guide for a discussion of the BRFSS and its limitations. The next series of exercises are based on BRFSS data.

a. From Table 2.1, locate the information on your State. Fill in the blanks below:

Percent of adults (in 2001) who received:	National average (%)*	Best-in-class average (%)*	Healthy People 2010 goal (%)*
HbA1c testing	61	82	50
Retinal eye examination	67	81	75
Foot examination	65	82	75
Flu vaccination	37	58	n/a

* Review the Resource Guide Appendix D for definitions of these terms. The figures are from Table D.1.

b. How does your State compare to the national, best-in-class, and Healthy People 2010 goal averages? Take your percent in the table above, subtract it from the national, best-in-class, and Healthy People 2010 figures, and write those figures in the table below:

Percent your State is above (+) or below (-)
Percent of adults (in 2001) who received:	National average (%)	Best-in-class average (%)	Healthy People 2010 goal (%)
HbA1c testing
Retinal eye examination
Foot examination
Flu vaccination			n/a

c. Select two States from Table 2.1 within your region or locality and write their figures down below. Then subtract your percent from their percents. How does your State compare?

Percent of adults (in 2001) who received	________ (State) (%)	Percent your State is above (+) or below (-) this State	_________ (State) (%)	Percent your State is above (+) or below (-) this State
HbA1c testing
Retinal eye examination
Foot examination
Flu vaccination

d. From your knowledge of your State demographics and health care providers, what roles do access issues, cultural barriers, insurance status, income, place of residence, or provider education have in your rates? What other access issues may influence diabetes care?

e. Where do you see the need for improvement?

f. If your State does not collect the diabetes measures mentioned in questions 2a, 2b, and 2c, would you use the Behavioral Risk Factor Surveillance System (BRFSS) to collect them? Why or why not?

g. What are some additional questions you have about the quality of diabetes care in your State?

3. Develop an inventory of the data systems available at the State and local levels.

a. Review Module 2 (beginning with MEPS) of the Resource Guide. Begin an inventory list of data sources available for your State. Also note how these data sources might be able to answer the questions you wrote down in exercises "e" and "g" above. You might also note questions you have about these data sources - things you want to find out from your data resource experts in the State.

Data source	Data available on your State? (Yes/No)	Notes
BRFSS
HCUP
State vital statistics
Disease registries
Medicaid health provider reimbursement claims
State employee health benefits claims
Census population data
Area Resource File
National Committee on Quality Assurance data
State Diabetes Prevention and Control Program (DPCP)
CDC Division of Diabetes Translation
Kaiser Family Foundation
Others:

4. Use published studies to arrive at State or local estimates.

Review Module 2 of the Resource Guide on using published studies.

a. What studies have been or are being conducted in your State on any of the six key areas for diabetes: complications, costs, prevalence, disparities, interventions, and return on investment?

b. Where do you see a need for further research?

5. Calculate the direct and indirect costs of diabetes for States and State Medicaid programs. The direct and indirect costs of diabetes for your State population and Medicaid population have been calculated from the literature and demographic information about your State.

Review further sections in Module 2 of the Resource Guide.

a. Direct costs are expenditures associated directly with treatment of the disease: routine services, treatment of complications, and medical conditions attributable to diabetes. Indirect costs are the lost opportunities or additional costs of living that affect individuals because they have diabetes: lost wages and productivity, the cost of dealing with impairments, premature death, etc. Do you have better estimates for costs from your State's Department of Health or Medicaid office than those listed in Table 2.2

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Your State estimates for spending on diabetes medical care would be more accurate than these derived through national studies and generalized assumptions.

b. From Table 2.3, find the figures for your State and the two States in question 2c above and fill in the blanks:

Data	Your State	Comparable State	Difference (+/-)	Comparable State	Difference (+/-)
Percent of population with diabetes
Direct cost of diabetes
Indirect cost of diabetes
Total cost burden

c. How do these figures compare with States you consider similar to your State?

d. What do you think the differences are related to? Can you document any of that with data from your State's Department of Health?

e. Would you be able to use these figures in making the case for diabetes care quality improvement?

f. Who would you contact in your State to get these measures calculated from actual data in your State?

Current as of August 2008

Internet Citation: Module 2: Data — Understanding the Foundation of Quality Improvement: Diabetes Care Quality Improvement: A Workbook for State Action. August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/diabwork/diabqworkmod2.html