Focus on Diabetes

Introduction

Advancing Health Care Quality Improvement 

The National Committee for Quality Assurance (NCQA) and Pfizer Inc are pleased to present the third edition of Quality Profiles: The Leadership Series, which focuses on diabetes quality of care issues. This series of publications is intended to help health care organizations move farther along the quality continuum toward excellent patient care.

NCQA and its constituents in the health plan, purchaser, physician, health care provider, and patient communities have helped drive substantial improvements in the delivery of health care by leveraging the power of performance measurement and accountability. However, too many people still suffer and die because the health care system fails to consistently deliver care that is known to be effective.

A major key to further progress for the health care system is a fundamental shift in focus from tertiary care to secondary and primary prevention of disease. Health plans, disease management organizations, and medical groups should continue to use their unique access to practitioners, patients, and purchasers to lead the transformation of American health care into a coordinated, patient-centered, evidence-based system.

Quality Profiles: The Leadership Series explores the implications of quality improvement (QI), the rationale for change, and the barriers to improvements in the context of an expanded discussion of the personal, social, and economic impact of the disease conditions under review. The overall goal of this series is to provide health care organizations and employers with a rich, up-to-date collection of QI resources, illustrated by case studies, to use as a foundation for new program development.

This edition of Quality Profiles: The Leadership Series addresses the management of diabetes, which has a direct impact on productivity and health care costs, as well as its substantial effects on other disease states. This edition also explores the evolving awareness of prediabetes and metabolic syndrome as they relate to diabetes risk, plus additional discussion of the underlying challenge of overweight/obesity. Individual QIA profiles and case studies are integrated into the clinical discussion of diabetes to better highlight specific contributions to disease management.

In Quality Profiles: The Leadership Series--Focus on Diabetes, we provide comprehensive descriptions of two QIAs, along with condensed summaries of several additional activities. As in previous publications, we have used a format designed to make the profiles easy to understand, adapt, and implement, comprising the following information:

• Selecting the activity: Analysis of a quality issue and its effect on the covered population; identification of activity and anticipated impact.
• Setting activity parameters: Establishment of QIA methods defining the population, specifying data sources and collection, identifying goals and barriers)
• Implementing the initiative: Review of specific interventions and outcomes; analysis of interventions with respect to QIA goals and barriers
• Epilogue: Analysis of overall QIA organizational impact, sustainability, and future directions

Additional case studies and examples are highlighted as:

• Quality Lessons: Summary of key points and observations about the QIA
• Quality Options: Examples of health care organizations’ QI initiatives that address similar issues in comparable populations

Overall, health care organizations that are listed in the acknowledgements (page 13) as “participating” provided additional supporting documentation, plus engaged in an interview process for supplementary fact gathering. Activities from those organizations that are deemed “contributing” were summarized without the in-depth interview process.

METHODOLOGY

The following criteria were used to make selections for inclusion in this edition of Quality Profiles:

• Accreditation status: The organization must have attained a status of Excellent, Commendable, or Accredited; or, in the case of MBHOs, Full Accreditation
• QIA submission and review
• Employers, medical groups, and managed care organizations (MCOs) implementing interventions that:

• Improve quality of life
• Improve outcomes
• Are innovative and/or unique

We considered diabetes QIAs from health plans that earned NCQA Accreditation between May 2003 and December 2004 for inclusion in this publication. We then screened eligible QIAs in a two-phase process. The first phase evaluated QIAs against the following criteria:

• Meaningful improvement: NCQA’s Review Oversight Committee has determined that the QIA under review demonstrated meaningful improvement (with regard to better outcomes for the affected population and/or impact on high-volume, high-risk, or high-cost conditions) that could be directly attributed to the strength, quality, and duration of the activity.
• Health care area: The QIA addresses a quality issue specific to the prevention or management of diabetes. During the second phase of the selection process, specially trained, independent consultants reviewed the QIAs that met the phase one eligibility requirements, using the following criteria:

• Nature of the QIA
• Health impact of the QIA
• Evidence of QIA sustainability

This two-phase process yielded the highest-scoring initiatives. We then interviewed the organizations that developed these QIAs to gather additional information on the methodology, barriers to the initiative, adjustments to the interventions (if any), and the progress of the initiative since the original submission. We integrated this information in order to develop the reviews included in Quality Profiles—Focus on Diabetes. Note that the quantitative graphs and tables included in the reviews are based solely on information and data that was reviewed or validated during the NCQA Accreditation process and was subject to the full two-phase selection process.

The initiatives highlighted in Quality Profiles were selected based on an independent, peer-reviewed process led by the NCQA, and reflect initiatives developed and led by the participants and contributing organizations

HEDIS (Health Plan Employer Data and Information Set) is a registered trademark of NCQA.

NCQA AND PFIZER: Quality Profiles Partnership

Quality Profiles: The Leadership Series has been developed as a useful resource for organizations undertaking QI initiatives. It provides both a clinical rationale for improvement and examples of challenges and successes involved in specific QIA implementation. The series is the product of a partnership between two organizations that share a deep commitment to advancing quality in health care: NCQA, which for 15 years has worked to improve health care delivery through its accreditation, certification, and recognition programs and the ongoing development of HEDIS measures and Pfizer Inc, the world’s leading research-based pharmaceutical company, which partners with health plans, medical groups, and other health care organizations to facilitate clinical excellence and improve patient outcomes. Pfizer has also long been a supporter of NCQA and its mission to improve the quality of health care.

Participating Health Care Organizations and Employers

Contributing Health Care Organizations

Quality Profiles Peer Reviewers

Patricia Beauvais, MA, RN
Erick M. Davis, MD
Lucia S. Hatch, MPH
Marie Howson, RN, MBA
Patricia Meyer, RN, BS
Linda Yazvac, MD

NCQA Staff Members

Kathleen C. Mudd, MBA, RN
Vice President for Product Delivery

L. Gregory Pawlson, MD, MPH
Executive Vice President

Elizabeth M. Usher
Vice President for Communications and Marketing

Elizabeth Usher
Assistant Vice President, Customer Resources

Pfizer Staff Members

Benjamin Eng, MD, MA
Senior Medical Director

Jeff Henderson
Senior Director, National Accounts, HMDS

Lindsay S. Rosen
Director, Quality Initiatives & Customer Collaboration

David Schaaf, MD
Medical Director


NCQA and Pfizer Inc would like to acknowledge and thank The Eden Communications Group for assisting in the development of this publication. Specifically, we would like to thank Rick Ambrosia, Jaime Brennan, Carol Delage, MSN, Deborah DeLuca, Stephanie Gabelmann, Sue Lindley-Howard, Donna Malik, Margaret C. Reith, RN, Maureen M. Saks, Annie Thomas, Kate Van Dyke, Erin Watson, and Tom Weid.
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