To the Editor.
—Dr Weiner and colleagues1 used administrative data to study the quality of care in elderly diabetic patients. They summarize that the patients did not receive "optimal care" and that "existing administrative claims data can be used to support quality improvement activities." In Germany comparable data were collected in 1988. Glycosylated hemoglobin was measured in only 8.2% of diabetic patients.2 Administrative data might be useful as indicators of process quality for quality improvement strategies if they become available more rapidly, since in Germany a substantial increase of glycosylated hemoglobin measurements occurred between 1988 and 1994 (Figure). Before blaming colleagues in Alabama, Maryland, and Iowa, more recent data should be provided. Another aspect is astonishing for European readers of JAMA: in 55% of the patients, cholesterol level was measured once per year, and this percentage is considered to be too low. In Europe, there is a fundamental
Joergens V, Gruesser M. Quality of Outpatient Care: Diabetes. JAMA. 1995;274(20):1584-1585. doi:10.1001/jama.1995.03530200020018