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HSR&D Investigators Propose New Measure to Assess Diabetes Care Quality


In the current healthcare climate there is increasing demand for maximum value in healthcare, such as improving quality while containing costs. Efficiency, as defined by the Institute of Medicine in their Quality Chasm report, is “the highest possible quality given limited resources.” Because of its prevalence and cost, diabetes is a prototype disease for which to develop efficiency measures. This article discusses a conceptual framework for assessing the efficiency of pharmacologic control of three important risk factors for diabetes (glucose, blood pressure, and cholesterol) because of their central role in diabetes management, and policy implications related to higher medication costs.

The authors note that a growing body of evidence indicates a need for more flexible measures of diabetes quality of care. Thus, rather than a single optimal threshold approach, they suggest a new framework for measuring quality of care that incorporates the benefit of incremental improvement among multiple populations that differ by age, diabetes duration, and co-existing illness. The new paradigm would assess pharmaceutical efficiency using quality-adjusted life years (QALYs), calculated separately within multiple age/risk categories, as the output (numerator) and acquisition costs of medications as the input (denominator). The QALYs/cost ratio will provide an assessment of the efficiency of pharmacologic utilization. Therefore, measuring efficiency in the treatment of glucose, blood pressure, and cholesterol in persons with diabetes would incorporate the evaluation of a future healthcare benefit that is “purchased” by direct pharmaceutical costs, linking expected healthcare benefits to actual costs.

Pogach L and Aron D. A proposal for a new measure to assess efficiency of diabetes care. Journal of Clinical Outcomes Management June 2009;16(6):263-70.

Drs. Pogach and Aron are Clinical Coordinators for VA/HSR&D’s Diabetes Mellitus Quality Enhancement Research Initiative (DM-QUERI).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.