Summary
This article evaluates an outcome measure (glycated haemoglobin levels) and 5 process measures (retinal examinations, proteinuria, glycated haemoglobin, foot examinations and lipids) for diabetes care in both health maintenance organisation (HMO) and fee-for-service settings. The mean glycated haemoglobin levels were very similar in 3140 patients followed in a fee-for-service setting (9.59%) and 4449 patients seen in an HMO setting (9.51%).
Studies in both settings where the upper limit of normal for the assay used was given showed that the mean glycated haemoglobin level in 5387 patients was 2.65% above this value. All process measures were far below the American Diabetes Association’s (ADA) guidelines. The results were similar in HMO and fee-for-service settings but somewhat better, in general, in those Indian Health Service locations that have a specific structured diabetes programme in place. The level of diabetes care delivered is similar in fee-for-service and HMO settings but falls far short of ADA guidelines.
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About the Author: Dr Mayer B. Davidson is Associate Director of Clinical Diabetes at the City of Hope National Medical Center, and Clinical Professor of Medicine at the UCLA School of Medicine. He is currently President of the American Diabetes Association. His research interests include mechanisms of insulin resistance and improving diabetes care.
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Davidson, M.B. Diabetes Care in Health Maintenance Organisation and Fee-For-Service Settings. Dis-Manage-Health-Outcomes 2, 189–197 (1997). https://doi.org/10.2165/00115677-199702040-00003
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DOI: https://doi.org/10.2165/00115677-199702040-00003