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Quality Improvement Effort Pays Off in Diabetes Care

anged at 17 Midwestern FQHCs that participated in the Health Disparities Collaborativesa national, federally funded quality-improvement initiative launched in 1998.

The program was designed to make certain that patients at these FQHCs, which provide primary care services in underserved urban and rural communities, received the current standard of care. This includes regular testing for glycosylated hemoglobin (a measure of blood sugar control), assessment of fats and cholesterol in the blood, eye exams and blood pressure checks, with appropriate follow-up. It also involves preventive treatments such as the use of ACE inhibitors, which can treat high blood pressure and heart failure, and aspirin, which can prevent heart attacks and strokes.

After reviewing four years of charts for 80 patients from each of the 17 centers, the researchers reported that "multiple components of care improved from 1998 to 2002." Annual glycosylated hemoglobin testing increased from 71 percent to 92 percent of patients. Blood lipid testing rose from 15 percent to 44 percent. Eye exams went from 25 percent to 44 percent. Prescriptions for ACE inhibitors rose from 33 percent of patients to 55 percent, and aspirin prescriptions rose from 22 percent to 45 percent.

These improvements added very little expense. The diabetes quality-improvement program cost about $700 per patient the first year, $600 the second year, $500 the third year and leveled off at $378 per year beginning in year four.

The researchers then estimated how much the patients' risk for the major complications from diabetes would be decreased if these improvements were maintained. Better care, they concluded, should reduce the lifetime incidence of blindness from 17 percent of patients down to 15 percent, of kidney failure from 18 down to 15 percent and of coronary artery disease from 28 to 24 percent.

Next they tried to place a dollar value on the benefits of
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