Original article
Vision loss among diabetics in a group model health maintenance organization (HMO)

https://doi.org/10.1016/S0002-9394(01)01364-2Get rights and content

Abstract

PURPOSE : To report the management of diabetic retinopathy in one group model health maintenance organization and assess the quality of care.

METHODS : Cross-sectional study. A chart review of 1200 randomly identified patients with diabetes mellitus, continuously enrolled for 3 years in Kaiser Permanente (KP) Southern California, the largest provider of managed care in Southern California, was performed. A total of 1047 patients were included in the analyses. Patient characteristics as well as information from the last eye examination were abstracted. Charts from patients with visual acuity less than 20/200 in their better eye (legal blindness) were selected for extensive chart review to determine the cause of visual loss and the antecedent process of care. T tests or the Wilcoxon rank sum test was used to compare continuous variables. The χ2 test or the Fisher exact test was used to compare categorical variables. All analyses were performed on the Statistical Analyses System (SAS Institute, North Carolina).

RESULTS : Our study population of 1047 diabetic patients was 51.7% male, had a mean age of 60.4 years, a mean duration of diabetes of 9.6 years, and a mean hemoglobin A1c of 8.3%. During the study period, 77.5% of patients received a screening eye examination with examination by an ophthalmologist, an optometrist, or review of a retinal photograph. Of those with a visual acuity assessment (n = 687, 65.6% of 1047), 1.5% had visual acuity of 20/200 or worse (legally blind) in the better eye, while 8.2% had this level of visual acuity in the worse eye. Of eyes with new onset clinically significant macular edema and visual acuity < 20/40, 40% had documentation of focal laser performed within 1 month of diagnosis. Of eyes with vitreous hemorrhage and visual acuity < 20/40, 50% had documentation of vitrectomy. Among eyes that had vitrectomy, over 80% had this procedure within 1 year of diagnosis of vitreous hemorrhage.

CONCLUSIONS : The current report is the largest study of diabetic retinopathy outcomes among patients enrolled in a prepaid health plan. Further research is necessary to investigate the impact of managed care on health outcomes.

Section snippets

Methods

We studied management of diabetic retinopathy in Kaiser Permanente (KP) Southern California. KP, a group model health maintenance organization, is the largest provider of managed care in Southern California and insures approximately 23% of insured patients. Charts were reviewed for information recorded during the 2 year study period (January 1, 1996 and December 31,1997). The following was recorded: current age, last name, gender, age of onset of diabetes, eye care information (date of last

Results

Our study population was 51.7% male, had a mean age of 60.4 years, a mean duration of diabetes of 9.6 years, and a mean hemoglobin A1c of 8.3% (Table 1). During the study period, 77.5% of patients received a screening eye examination with examination by an ophthalmologist, an optometrist, or review of a retinal photograph. Table 2 describes the mean visual acuity in the better and worse eye. In 1.5% of patients, the visual acuity in the better eye was 20/200 or worse (legally blind), while

Discussion

Evaluating eye care provided by managed care organizations is important because many people are enrolled in these programs. To protect the health of these patients, it is our responsibility to evaluate their care and advocate for them. We chose to study diabetes eye care because intervention has been shown to prevent blindness and also because it has been identified by the National Committee on Quality Assurance (NCQA) as a HEDIS (Health plan Employer Data and Information Set) measure. While

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