Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Where We Are Indexed
Past Issue Archives
Clinical Communication
In Review
Editorial Board
Information for Authors
Author Form

Reprints, Permissions, & Copyright
Site Map
BACK ISSUE articles are $15 each.
International credit cards NOT accepted.

JCOM Paid Subscribers
user name:
Forgot password?

JCOM Abstract

J Clin Outcomes Manage 
2009 Jun;16(6):263-270
A proposal for a new measure to assess efficiency of diabetes care
Pogach LM, Aron DC

Abstract Objective: To propose a conceptual framework for efficiency assessment in diabetes treatment based on the absolute population benefit obtained for the pharmaceutical costs of risk factor management. Methods: Descriptive report. Results: The risks and benefits of risk factor control differ substantially based on diabetes duration, life expectancy, and comorbid conditions. Additionally, the specific medications used to achieve control differ in efficacy, side effects, and costs. Therefore, current individual threshold and proposed composite all-or-none performance measures are not consistent with the clinical epidemiology of disease (eg, absolute risk reduction is continuous). Consequently, the use of such measures is not appropriate to assess value since the marginal quality and cost (efficiency) of incremental improvement cannot be ascertained. Additionally, presenting aggregate results may mask over- or undertreatment in specific subpopulations. We propose a new paradigm for assessing pharmaceutical efficiency using quality-adjusted life years, calculated separately within multiple age/risk categories, as the output (numerator) and acquisition costs of medications as the input (denominator). Conclusion: Assessment of efficiency in the treatment of glucose, blood pressure, and cholesterol in persons with diabetes should incorporate evaluation of the future health care benefit that is “purchased” by direct pharmaceutical costs. This will require para-digm shifts in conceptualizing quality measures as being continuous rather than dichotomous and evaluating benefit in multiple populations that may differ by age and comorbid conditions.

Search the Turner White index to find abstracts of articles published in JCOM.

New issues are posted one month following publication of the printed journal.

View past issue archives:    2013    2012    2011    2010    2009    2008    2007
   2006    2005    2004    2003     2002     2001     2000     1999

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2018, Turner White Communications
Updated 1/20/14 • jdw