An Instrumental Variable Analysis of the Impact of Practice Guidelines on Improving Quality of Care and Diabetes-Related Outcomes in the Elderly Medicare Population

Details

• Personal Author:
  Collins A ; Dowd B ; Gilbertson D ; Li S ; Liu L ; McBean M
• Description:
  The effect of the diabetes practice guideline recommending =2 HbA1c tests annually on diabetes-related outcomes was evaluated using Medicare claims data. The study population included 1998 and 1999 incident diabetes patients aged = 67 years, who were Medicare eligible and without known diabetes-related complications at baseline. Number of HbA1c tests was measured 1 year after diabetes incidence. All-cause death and diabetes complications were identified during follow-up, through December 2003. The analysis was conducted with an instrumental variable method and a bivariate probit model, controlling for individual, social, and health care system characteristics. Among 13,033 patients, 27.1% followed the practice guideline. Receiving =2 HbA1c tests annually was significantly associated with a decrease in probability of 28.8 percentage points for macrovascular complications, 28.7 for atherosclerotic heart disease, and 23.1 for chronic kidney disease or end-stage renal disease in the 4-year follow-up period. [Description provided by NIOSH]
• Subjects:
  Age Factors Aging Delivery Of Health Care Environmental Monitoring Epidemiology Health Care Facilities Workforce And Services Health Promotion Occupational Health Risk Assessment Safety Safety Management Surveys And Questionnaires

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• Keywords:
  Age-factors Age-groups Author Keywords: Diabetes Biological-function Biological-systems Diabetes Education Program Disease-incidence Exposure-assessment Exposure-levels Exposure-methods HbA1c Health-care Health-programs Health-services Health-standards Health-surveys Injury-prevention Instrumental Variable Mathematical-models Medical-care Medical-monitoring Medical-screening Medical-services Medical-treatment Medicare Quantitative-analysis Risk-analysis Safety-education Safety-measures Safety-practices Standards Statistical-analysis Testing

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• ISSN:
  1062-8606
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Minnesota ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  222-230
• Volume:
  23
• Issue:
  3
• NIOSHTIC Number:
  nn:20037542
• Citation:
  Am J Med Qual 2008 May; 23(3):222-230
• Contact Point Address:
  Allan J. Collins, MD, United States Renal Data System, 914 South 8th St, Suite S-206, Minneapolis, MN 55404
• Email:
  acollins@usrds.org
• Federal Fiscal Year:
  2008
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  American Journal of Medical Quality
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ed50fd9adb7f3efdb6a60598d8a4e5fd723086d60ff2e7d32e9cb8a7fe6387a31d38acd9aacad8829522b15bc50e134fecf4d18c74154fb8237d80058990620f
• Download URL:
  https://stacks.cdc.gov/view/cdc/188619/cdc_188619_DS1.pdf
• File Type:
  [PDF - 116.13 KB ]