The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

Avi Porath,Ronit Peled,Rachel Wilf-Miron,Nesia Gordon,Arkadi Bolotin

doi:10.1186/1472-6823-14-92

Abstract

BackgroundIn primary health care systems where member’s turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients’ health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs.MethodsA time series study with three quality indicators – Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank.Results96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003–2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively.ConclusionOur study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could “harvest” their investments in improving quality.

Highlights

In primary health care systems where member’s turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered
System-wide reengineering of care in the American Veterans Affairs (VA) healthcare system has resulted in significant improvements in diabetes care indicators [5,6]
The analysis included data collected on 96,553 registered adult patients with diabetes

Summary

Introduction

In primary health care systems where member’s turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered. The indicators covered management of chronic disease, practice organization, and patients’ experiences with respect to care [7]. This scheme was associated with improvements in recorded quality of diabetes care in the first year; modest improvements in subsequent years; and with variation in care between population groups which diminished under the incentives, but remained substantial in some cases [8]

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