Measuring the Quality of Diabetes Care for Older American Indian
Objectives: This study evaluated the quality of diabetes care for older American Indians and Alaska Natives.
Methods: We analyzed the Indian Health Service Diabetes Care and Outcomes Audit to determine whether completion of indicators of diabetes care differed as a function of age and whether additional patient and program factors were also associated with completion of the majority of the indicators.
Results: Completion rates varied by age group, with significantly lower rates seen among the youngest and oldest. Patient diabetes education and duration of diabetes were most strongly associated with the completion of the majority of these indicators.
Conclusions: Further studies are needed to determine effective interventions, including diabetes education, to improve the quality of diabetes care in the youngest and oldest age groups.
Diabetes is a serious problem for American Indian and Alaska Native (AIAN) populations, which suffer from some of the highest rates of diabetes in the world. In some AIAN communities, more than half the adult population has diabetes and the prevalence is increasing. Previous studies in the general population have found that the frequency of diabetes and its complications increases with age; similar trends are evident in AIAN communities. For instance, in the Strong Heart Study, a comprehensive epidemiological study of cardiovascular disease and its risk factors among 13 AIAN tribes, diabetes was found to be most common in the oldest age groups, with rates as high as 74% among women aged 65-74 years living in Arizona.
Recent studies have shown that intensive control of blood glucose levels and routine preventive screening can reduce complications among patients with diabetes. For example, the implementation of practice guidelines for routine foot care in an AIAN community was associated with a substantial reduction in lower extremity amputations over time. Generally, the quality of diabetes care has been defined, measured, and improved in AIAN communities using a combined clinical and public health approach. However, despite higher rates of diabetes and its complications in older individuals, no studies exist of the overall quality of care for older American Indians/Alaska Natives to determine whether they are receiving recommended medical care to prevent diabetes complications.
In this study, we measured the quality of diabetes care for American Indians/Alaska Natives to determine if differences existed as a function of age. Thus, we addressed the following questions: (1) Do differences exist in the quality of diabetes care for older American Indians/Alaska Natives compared with younger patients and (2) if so, what patient and health care program factors explain these differences?