J Clin Outcomes Manage
Evaluation of quality of diabetes care in a multiethnic, low-income population
Kirk JK, Bertoni AG, Grzywacz JG, Smith A, Arcury TA
Abstract: Objective: To evaluate glycemic and risk factor control for a cohort of patients with diabetes over a 1-year period and to determine the proportion of patients meeting clinical practice guideline treatment goals. Design: Retrospective, cross-sectional cohort study. Setting and participants: Primarily low-income persons with type 2 diabetes served by a rural community health clinic in North Carolina during 2006. Measures: Attainment of treatment goals related to glycated hemoglobin A1c (HbA1c), blood pressure, and lipid control. Descriptive statistics were applied to demographic variables. Mean differences in outcomes were assessed and multivariate logistic regression models were applied. Results: There were several differences in diabetes care indicators by ethnicity. Mean HbA1c levels and rates of HbA1c greater than 8% were higher among Hispanics compared with African Americans and non-Hispanic whites. African Americans were more likely than Hispanics or non-Hispanic whites to achieve a triglyceride level less than 150 mg/dL. Hispanics had a lower mean systolic blood pressure and were more likely to achieve the blood pressure target less than 130/80 mm Hg compared with African Americans or non-Hispanic whites. There were no differences by ethnicity in the simultaneous control of HbA1c, blood pressure, and low-density lipoprotein cholesterol. Conclusion: In this chart review, there was a significant disparity in HbA1c and total cholesterol levels achieved for Hispanics as compared with non-Hispanic whites and African Americans. In comparison with national data, however, Greene County Health Care is doing a comparable job meeting diabetes goals for HbA1c, blood pressure, and lipid levels and in some instances is achieving better outcomes despite predominantly low-income clients. Further evaluation is warranted to determine strategies that can help Hispanics meet diabetes goals.
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