February 16, 2011

Sudden Acceleration of Diabetes Quality Measures

Author Affiliations

Author Affiliations: Veterans Affairs New Jersey Healthcare System, East Orange (Dr Pogach); University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Dr Pogach); Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio (Dr Aron); and Case Western Reserve University, Cleveland (Dr Aron).

JAMA. 2011;305(7):709-710. doi:10.1001/jama.2011.153

The modern era in diabetes performance measurement began in 1997, when the Diabetes Quality Improvement Project (DQIP), the first national disease-specific measure, set recommended thresholds for intermediate outcomes (glycated hemoglobin [HbA1c] levels, blood pressure, and low-density lipoprotein cholesterol [LDL-C] levels). These thresholds, if not achieved, would clearly result in greater population morbidity and mortality. The DQIP explicitly stated that such threshold measures were neither guidelines nor standards and that lower intermediate outcome values should not be used for public reporting owing to lack of evidence for efficacy and the absence of validated risk-adjustment models that would allow for fair comparisons. Also in the 1990s, major randomized trials such as the Diabetes Control and Complications Trial, Scandinavian Simvastatin Survival Study, United Kingdom Prospective Diabetes Study, West of Scotland Coronary Prevention Study, and Hypertension Optimal Treatment Study established stronger evidence for treatment of intermediate-outcome risk factors. These pivotal studies provided the impetus for studies conducted from 2000 onward to determine optimal values for these risk factors to reduce cardiovascular risk in patients with longer duration of disease.

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