Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1029 — Racial Disparities in Diabetes Care Processes, Outcomes, and Treatment Intensity

Author List:
Heisler M (Center for Practice Management and Outcomes Research)
Zemencuk JK (Center for Practice Management and Outcomes Research)
Krein SL (Center for Practice Management and Outcomes Research)
Hayward RA (Center for Practice Management and Outcomes Research)
Piette JD (Center for Practice Management and Outcomes Research)
Kerr EA (Center for Practice Management and Outcomes Research)

Objectives:
The VA has made significant improvements in the overall quality of diabetes care. We sought to assess whether these improvements have also reduced previously documented racial disparities in diabetes care processes, intermediate outcomes, and treatment intensity in a random nationwide sample of VA diabetes patients.

Methods:
Observational study of 748 white and 144 African American patients in 51 VA facilities who completed the Ambulatory Care Survey of Healthcare Experiences of Patients (SHEP) in FY 2002 and for whom we had External Peer Review Program (EPRP) data on receipt of diabetes services (A1c, LDL, nephropathy screen, and dilated eye examinations), intermediate outcomes (glucose control measured by A1c; cholesterol control measured by LDL, and achieved level of blood pressure), and medications for certain conditions.

Results:
In FY02, rates of receiving recommended diabetes processes of care and intermediate measures of disease control were significantly higher for both white and African American veterans than those in a comparable review in FY2000. In FY02, there were no racial differences in receipt of an A1c test (93% vs. 96%) or of a dilated eye exam among eligible patients (69% vs. 72%). Rates of LDL checks were high, but African Americans were still less likely than whites to have an LDL checked in the past two years (90% vs. 98%, p<0.01) and to have a nephropathy screen (42% vs. 51%, p<0.01). After adjusting for patients’ age, education, income, insulin use, self-reported health status, and VA facility, racial disparities in receipt of an LDL test and nephropathy screen persisted. In unadjusted analyses, lower rates of African American patients had A1cs <8.0 (62% vs. 71%, p<0.01), LDLs less than 130 (65% vs. 74%, p<0.01), and blood pressures <140/90 (56% vs. 63%, p<0.01). After adjustment for other patient characteristics, race was no longer a significant independent predictor of having poor control of LDL, A1c, or blood pressure. Among those with poor blood pressure and lipid control, African Americans received as intensive treatment as whites for these conditions.

Implications:
In spite of significant improvements in rates of receiving necessary diabetes tests and in outcomes, there continue to be racial disparities in several diabetes care processes and intermediate outcome quality measures. There were no significant differences in intensity of treatment for those patients with poor control.

Impacts:
Improving overall care is not sufficient to eliminate racial disparities in VA diabetes care. Targeted interventions need to be developed that address patient, treatment, and system factors contributing to individual-level disparities.