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February 7, 2007

Measuring Progress Toward Achieving Hemoglobin A1c Goals in Diabetes Care: Pass/Fail or Partial Credit

Author Affiliations

Author Affiliations: New Jersey Veterans Healthcare System, East Orange (Dr Pogach); University of Medicine and Dentistry of New Jersey, Newark (Dr Pogach); Centers for Disease Control and Prevention, Atlanta, Ga (Dr Engelgau); and Louis Stokes Cleveland Veterans Affairs Medical Center and Case School of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr Aron).

JAMA. 2007;297(5):520-523. doi:10.1001/jama.297.5.520

Despite increasing recognition of the effect of diabetes on the health of the US population, there has been only modest improvement in glycemic control among most demographic groups from the 1990s to the early 2000s regardless of health care setting.1 Performance measurement should assess quality of care, which is defined by the Institute of Medicine as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.2 Consequently, hemoglobin A1c (HbA1c) control is an important intermediate outcome for measuring the quality of care provided to the 21 million Americans with diabetes. However, considerable debate exists concerning which HbA1c levels are appropriate for public reporting when quality assessments are compared across multiple health care systems.