Glycemic and Lipid Control among Patients with Diabetes at Six U.S. Public Hospitals

Public hospital systems share a mission to provide access to healthcare regardless of ability to pay. While public hospital systems care for large numbers of socioeconomically vulnerable and ethnically diverse populations who have diabetes, little is known about the quality of diabetes care provided...

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Bibliographic Details
Published in:Journal of health care for the poor and underserved 2008-11, Vol.19 (4), p.1060-1075
Main Authors: Chew, Lisa D, Schillinger, Dean, Maynard, Charles, Lessler, Daniel S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Alliances
Continental Population Groups - statistics & numerical data
Diabetes
Diabetes Mellitus - blood
Diabetes Mellitus - ethnology
Diabetes Mellitus - therapy
Diabetics
Female
Glycaemic control
Glycated Hemoglobin A - analogs & derivatives
Glycated Hemoglobin A - analysis
Health inequalities
Healthcare Disparities - statistics & numerical data
Hospitals
Hospitals, Public - statistics & numerical data
Humans
Insurance Coverage - statistics & numerical data
Insurance, Health - statistics & numerical data
Lipids
Lipids - blood
Male
Middle Aged
Poverty - statistics & numerical data
Quality of care
Quality of Health Care - statistics & numerical data
Socioeconomic Factors
Studies
United States
Young Adult
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Summary:Public hospital systems share a mission to provide access to healthcare regardless of ability to pay. While public hospital systems care for large numbers of socioeconomically vulnerable and ethnically diverse populations who have diabetes, little is known about the quality of diabetes care provided in these sites. We assessed the measurement and control of hemoglobin A1c (HbA1c) and lipids (LDL) in a sample of patients with diabetes with > or =2 outpatient visits per year in two consecutive years at one of 6 public hospitals (N=14,222). High proportions of patients had at least one HbA1c and LDL measurement within 2 years (89% and 88%, respectively). Thirty-five percent had HbA1c < 7.0%; 21% had HbA1c > or =9.5%; 36% had LDL160 mg/dl. Non-White patients and patients who were never insured were most at risk for poor glycemic and lipid control. The quality of care, as measured by glycemic and lipid monitoring and control among ongoing users of public hospital systems, was similar to that of other health systems, but disparities exist across race/ethnicity and insurance status. Because of the critical role these institutions play in providing care to the underserved, research is needed to explore factors contributing to differences in glycemic and lipid control and develop strategies to improve chronic disease management in these systems.
ISSN:1049-2089
1548-6869
1548-6869
DOI:10.1353/hpu.0.0079