Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. In this cross-sectional study...

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Bibliographic Details
Published in:American journal of public health (1971) 2008-11, Vol.98 (11), p.2079-2084
Main Authors: Roubideaux, Yvette, Noonan, Carolyn, Goldberg, Jack H, Valdez, S. Lorraine, Brown, Tammy L, Manson, Spero M, Acton, Kelly
Format: Article
Language:English
Subjects:
Adult
Aged
Alaska
Audits
Biological and medical sciences
Blood Pressure Determination - utilization
Cholesterol
Clinical outcomes
Cross-Sectional Studies
Diabetes
Diabetes Mellitus - ethnology
Diabetes Mellitus - prevention & control
Diabetes Mellitus - therapy
Diabetes. Impaired glucose tolerance
Education
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Gender
Glycated Hemoglobin A - analysis
Health facilities
Health services
Health Services, Indigenous - organization & administration
Health Services, Indigenous - standards
Hemoglobin
Hospitals
Humans
Immunization
Indians, North American - education
Inuits - education
Laboratories
Lipids - blood
Male
Mass Screening - methods
Mass Screening - utilization
Medical sciences
Medicare
Middle Aged
Miscellaneous
Native North Americans
Patient Education as Topic - organization & administration
Patient Education as Topic - standards
Patients
Pharmacists
Prevention and actions
Prevention programs
Program Evaluation
Public health
Public Health Administration - standards
Public health. Hygiene
Public health. Hygiene-occupational medicine
Quality Indicators, Health Care
Regression analysis
Reimbursement
Research and Practice
Rural Health
Sample size
United States
United States Indian Health Service
Urban Health
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Summary:We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2007.110478