TY - JOUR
T1 - An instrumental variable analysis of the impact of practice guidelines on improving quality of care and diabetes-related outcomes in the elderly medicare population
AU - Li, Suying
AU - Liu, Jiannong
AU - Gilbertson, David
AU - McBean, Marshall
AU - Dowd, Bryan
AU - Collins, Allan
PY - 2008/5
Y1 - 2008/5
N2 - 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. (Am J Med Qual 2008;23: 222-230).
AB - 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. (Am J Med Qual 2008;23: 222-230).
KW - Diabetes
KW - Diabetes education program
KW - HbA1c testing
KW - Instrumental variable
KW - Medicare
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U2 - 10.1177/1062860608314940
DO - 10.1177/1062860608314940
M3 - Article
C2 - 18539984
AN - SCOPUS:43949096202
SN - 1062-8606
VL - 23
SP - 222
EP - 230
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
IS - 3
ER -