标题：Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act
摘要：Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system. Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals. Rates of morbidity and mortality among people with diabetes mellitus can be improved by controlling blood glucose, blood pressure, and lipid levels. 1 – 5 Health care systems can help people better control their diabetes by allocating resources to and ensuring the quality of a broad array of population-based and individually targeted education, nutrition, and medical therapies. 6 – 9 Glucose, blood pressure, and lipid control can therefore be used globally as an indicator of the quality of diabetes care services within a particular health care delivery system. The Indian Health Service (IHS) is a federally operated system that provides health care, along with tribal and urban programs, to more than 1.5 million American Indians and Alaska Natives, of whom approximately 100 000 have been diagnosed with diabetes. Assessing the quality of diabetes care in the IHS health care delivery system is important for 2 major reasons. First, in addition to this population’s disproportionately heavy burden of diabetes, American Indians and Alaska Natives with diabetes appear to be at particularly high risk of developing complications. 10 – 13 Thus, delivery of high-quality care is an important strategy to eliminate the health disparities that result from diabetes in this population. Second, in the past decade, a substantial re-focusing on diabetes has been undertaken by communities, health systems, and Congress. This focus has resulted in an increased interest in federal agency performance measurement and reporting as a means of judging effectiveness and maintaining accountability. We estimated quality of diabetes care in the IHS health care delivery system by examining system-level changes in blood glucose, blood pressure, and lipid control over the period from 1995 to 2001.
