Louisiana Health Care Review
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION
Diabetes Management
Preventive Services Improve Quality of Life
Louisiana’s diabetes management rates for Medicare beneficiaries are among the lowest in the nation. The HbA1c Monitoring rate is 69.3%, ranking 48th in the nation. The Biennial Lipid Profile rate is 71.3%, 35th among the states. The rate of diabetes patients having a Biennial Eye Exam is 63.4%, ranking 46th nationally.
Below is a summary of one of America's major threats to public health, diabetes. Also included are the Diabetes Project's objectives for improving quality of care for Medicare beneficiaries with diabetes.  LHCR and CMS are working to increase the use of diabetes management preventive services for Medicare beneficiaries with diabetes.
 

Public Health Importance
Diabetes is a major public health problem and is becoming more prevalent in all age groups.  The increasing prevalence is attributed both to higher detection and to poorer health habits (increased rates of obesity being the primary culprit).

According to the National Health Interview Survey, the prevalence of Type II diabetes is 1.3 percent at 18-44 years, 6.2 percent at 45-64 years, and 10.4 percent for those aged 65 and older.(1) Based on oral glucose testing in the National Health and Nutrition Examination Survey, there is one undiagnosed case of diabetes for every diagnosed case.

Individuals with diabetes have death rates twice that of the general U.S. population.  They are also disproportionably affected by disability at rates 2 to 3 times higher than reported by individuals without diabetes (NHIS).

In addition to the increased morbidity and mortality that occur in individuals with diabetes, the financial costs to patients and to society are great.  Individuals with diabetes have 2 to 5 times higher per capita total medical expenditures and per capita out-of-pocket expenditures than people without diabetes.(2) 

Health care costs for diabetes have been estimated to be around $92 billion in 1992 dollars.  (View Footnotes)
Louisiana Data and Opportunity for Improvement
 Louisiana’s diabetes management rates for Medicare beneficiaries are among the lowest in the nation. The HbA1c Monitoring rate is 69.3%, ranking 48th in the nation. The Biennial Lipid Profile rate is 71.3%, 35th among the states. The rate of diabetes patients have a Biennial Eye Exam is 63.4%, ranking 46th nationally.
CMS Measure Specifications for Diabetes
Quality Measures Criterion Met or Acceptable Alternative
1. Diabetes patients having annual hemoglobin A1c (HbA1c) monitoring.

A Medicare claim record of HbA1c test.
2. Diabetes patients having a biennial lipid profile.

A Medicare claim record of a lipid profile or the three individual components of a lipid profile (total cholesterol, high density lipoproteins and triglycerides)

3. Diabetes patients having a biennial eye exam.

A Medicare claim record of an eye exam performed by an eye care professional or an eye procedure that also involves the examination of the retina.
Increase Diabetes Management Rates in Your Clinic
The health care team working with the beneficiary with diabetes can play a major role in improving disease outcomes by providing appropriate medical care and monitoring and by supporting healthy lifestyle choices.  Diabetes and the complications of the disease can be prevented or delayed by management of blood glucose through diet, exercise, and medication, by management of other risk factors such as lipids, blood pressure, smoking, and by appropriate and timely examinations and treatment (e.g., eyes and feet).

The short-term objectives for statewide improvement projects are to increase the rates of key examinations and laboratory tests.  In optional projects, intermediate health outcomes (such as blood pressure control) will also be measured.

Diabetes and Diabetes Management Web Sites
Here is a list of informative Web sites related to Diabetes and Diabetes Management.

 


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resources, visit www.medqic.org

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