An instrumental variable analysis of the impact of practice guidelines on improving quality of care and diabetes-related outcomes in the elderly medicare population

Suying Li, Jiannong Liu, David Gilbertson, Marshall McBean, Bryan Dowd, Allan Collins

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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).

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalAmerican Journal of Medical Quality
Volume23
Issue number3
DOIs
StatePublished - May 2008

Keywords

  • Diabetes
  • Diabetes education program
  • HbA1c testing
  • Instrumental variable
  • Medicare

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