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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3090 — Improving Care for Veterans with Diabetes: Analysing Rates of Lower-Extremity Amputation

Author List:
Siddharthan K (James Haley VAMC,VISN8)
Bass EA (James Haley VAMC, VISN8)
Campbell R (James Haley VAMC, VISN8)

Objectives:
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) reflect ambulatory care sensitive conditions. They can be used to identify, with inpatient data, apparent variations in the quality of inpatient or outpatient care by tracking hospitalizations for conditions that should be treatable on an outpatient basis or that could be less severe if treated early and appropriately. Our objective is to apply AHRQ PQIs to study the rate of lower-extremity amputations among veteran populations admitted with a diagnosis of diabetes in the Veterans Health Administration (VHA).

Methods:
In our study PQIs are defined as the rates of lower-extremity amputations (characterized by AHRQ as one of 10 ICD-9-CM procedural codes) in patients admitted with a primary or secondary diagnosis of diabetes (one of 40 ICD-9-CM diagnosis codes excluding any diagnosis of trauma) across the 22 VHA Veteran Integrated Service Networks (VISNs) for the period 1998-2002. In general, a lower value of the PQI is desirable implying proper treatment and glucose control that may reduce the incidence of lower-extremity amputation and indicate better quality preventive care.

Results:
We used the VHA Medical SAS Inpatient Datasets to calculate PQIs. After adjusting for age, PQIs for discharges for lower-extremity amputation averaged 27.3 per 1000 admissions with a diagnosis code for diabetes across VISNs for 1998-2002. No trend was evident (p<.01) in the VHA in PQIs over the five years of analysis. The top quartile comprising of the five VISNs with the highest PQI scores (mean of 38) was significantly (p<.01) different from those at the bottom quartile with an average PQI of 18 lower-extremity amputations per 1000 admissions.

Implications:
Disparities exist across VISNs in rates of lower extremity amputations. Over the five years of observation the same three VISNs consistently were in the top quartile requiring more research on underlying reasons and possible community based interventions.

Impacts:
In this study we have demonstrated the use of AHRQ Patient Quality Indicators as a measure of overall quality in health care provision to veterans with diabetes. The impact of this study is hopefully to stimulate further research using inpatient and outpatient data jointly to investigate the effect of environmental conditions, patient adherence to treatment recommendations and determine best methodologies to prevent complications due to untreated diabetes.


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