PATIENT EXPERIENCE WITH CARE AND CLINICAL OUTCOMES IN DIABETES: A CASE FOR MORE PERSON-CENTERED MEASUREMENT

Abstract

Rationale, aims and objectives: Diabetes performance metrics are widely used to assess care, inform the public, guide reimbursement, and facilitate quality improvement efforts. The most common, the D5, is a composite process and intermediate outcome measure that may not capture key patient-important outcomes. This study assesses the ability of the D5 and the Patient Assessment of Chronic Illness Care (PACIC) instrument to evaluate patient experience with care. Method: Postal surveys with the PACIC instrument, and questions about demographics, health status, and self-efficacy were mailed to 4796 adults from a diabetes registry maintained by 34 primary care clinics in November 2009. D5 measures for 2009 (glycosylated hemoglobin <8%, blood pressure <140/90 mmHg, low density lipoprotein cholesterol <100 mg/dL (2.59 mmol/L), non-smoking, aspirin therapy) were obtained from electronic medical records. Logistic regression analysis evaluated the association of PACIC, self-reported health, demographics, and D5.Results: The 2055 (42.8%) respondents had mean age 64.9 years (standard deviation (SD), 12.3), HbA1c 6.9% (SD, 1.2%), and PACIC 3.0 (SD, 1.1); 43.8% achieved the D5. Self-reported diabetes control and lack of perceived financial barriers to medical care were associated with achieving the D5; however, PACIC and other patient-reported measures of health were not associated with achieving the D5. In contrast, diabetes self-management education, social support network, and self-efficacy were associated with higher PACIC scores.Conclusions: Efforts to improve patient-centered care necessitates the assessment of patient experience of health and healthcare. The PACIC may be an important adjunct to the D5 to measure the quality of diabetes care.