Management Brief uHealth Services Research & Development Service uNo. 6, December, 2002

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MANAGEMENT BRIEF provides VA senior management with a timely and concise summary of an

important HSR&D finding or publication.

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(Please forward this information to other interested parties)

Accounting for practice variation for patients with diabetes

The effect of provider profiling on changing practice patterns has been mixed.

Patient care depends on both the individual health care provider and the health care

system, yet most studies on practice variation profile only the individual practitioners.

Findings from an HSR&D study recently published in Health Services Research looked

at the amount of variation in the care of veteran patients with diabetes, and then evaluated

the amount of variation attributable not only to their primary care provider (PCP), but

also to the provider group and facility. Investigators assessed pharmacy, laboratory, and

primary care provider data available through the Veterans Health Information Systems

and Technology Architecture (VistA) – a local clinical information system used by all

VAMCs. Data used in this study included more than 12,000 patients, 258 primary care

providers, 42 provider groups, and 13 facilities. Overall, findings show that the facilities

are doing well in providing care for patients with diabetes. For example, findings

indicate that more than 80% of the patients had an HbA1c obtained within the past year,

57% had a lipid panel done, and nearly 40% had their LDL-C measured. However,

although investigators found little variation in diabetes care practices attributable to

PCPs, there was a fair amount of variation among facilities. This suggests that increased

emphasis on constructing and examining facility/clinic level profiles may be more

productive than profiling individual providers. This is in contrast to what many sectors of

the greater health care industry are doing -- conducting campaigns to profile individual

health care providers as a way to contain costs and control practice variation, thus

improving the quality of care. Study results also suggest that the development and use of

quality indicators that support and promote specific, high-priority clinical actions may be

a more effective way to improve the quality of care for patients with diabetes.

Krein SL, Hofer TP, Kerr EA, Hayward RA. Whom should we profile? Examining diabetes care

practice variation among primary care providers, provider groups, and health care facilities.

Health Services Research 2002 Oct;37(5):1159-80.

This study was supported, in part, through HSR&D’s Diabetes Mellitus Quality Enhancement

Research Initiative (QUERI). In addition, Drs. Hofer and Kerr were HSR&D Career

Development Award recipients at the time of the study.

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