2011 National Meeting

1076 — Partial Credit Glycemic Measures for Older Veterans Not Receiving Insulin Therapy

Soroka O (REAP East Orange) , Rajan M (REAP East Orange), Maney M (REAP East Orange), Pogach LM (REAP East Orange)

The < 8% A1c HEDIS performance measure for glycemic control is applicable to all seniors. However, not all patients should or are able to achieve this value, and the use of insulin is dependent upon shared decision making. The Office of Quality and Performance is collaborating with DM-QUERI and Office of Patient Care Services Subspecialty Care to evaluate a partial credit measure for glycemic control. Our objective was to evaluate the impact of awarding partial credit for referrals and medication changes upon adherence rates for veterans not receiving insulin.

This is a retrospective cross-sectional data analysis of the VA Diabetes Epidemiology Cohort (DEpiC) for fiscal years 2003 and 2004. We identified 153,132 veterans aged 65-74 years in FY2003 not receiving insulin therapy, having at least one A1c test in FY2003 and alive at the end of FY2003. If the first A1c was < 8%, the measure was met. For individuals with an A1c > = 8%, we evaluated whether the following actions were taken within a period of six months: subsequent A1c < 8% or patient started on insulin = 100% credit; new oral medication started = 50% credit; visit to endocrinology, diabetes, nutrition, or diabetes education clinic documented using stop code: 25% credit; no A1c or A1c > 9% = no credit.

The cohort was 99% male, 86% white, and 72% currently married. The mean initial A1c was 7% (SD 1.3%). 126,547 (82.6%) had an A1c test < 8% in FY2003. Of the remaining 26,585 veterans, 2,287 (8.6%) passed because they received insulin. Of the remaining patients (not on insulin) 6,485 (24.4%) passed with an A1c < 8%; 3,181 (11.9%) failed with an A1c > 9%. The overall failure rate reduced from 17.4% to 6.4% after applying subsequent full/partial credits to the denominator.

These results suggest that clinicians not only have a high rate of meeting the measure as defined, but take reasonable actions in the majority of the remaining patients.

Further evaluation is necessary to determine relative contraindications to increasing medical therapy and whether or not treatment intensification is associated with adverse outcomes such as hypoglycemia. These results could further define the denominator for a partial credit measure.