Effect of Veterans Administration use on indicators of diabetes care in a national sample of veterans. Diabetes Technol Ther 2010 Jun;12(6):427-33
Date
05/18/2010Pubmed ID
20470227Pubmed Central ID
PMC3690004DOI
10.1089/dia.2009.0171Scopus ID
2-s2.0-77955913179 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Diabetes poses a serious health burden, of which veterans have a disproportionate share. Few data exist regarding differences in self-care behaviors and provider-based quality of care indicators among a large sample of veterans. The objective of this study was to determine the effect of Veterans Affairs (VA) use on diabetes quality of care indicators among veterans.
METHODS: A cross-sectional analysis was done on data from 36,525 veterans in the 2003 Behavioral Risk Factor Surveillance Survey. VA use was defined as receiving some or all health care from a VA facility in the previous 12 months. Diabetes quality indicators such as two or more provider visits, two or more hemoglobin A1c tests, and flu and pneumonia shots were compared between VA users and non-VA users. The independent effect of VA use on each quality indicator was analyzed with multiple regression using STATA version 10 (Stata Press, College Station, TX) to account for the complex survey design and yield population estimates.
RESULTS: Among veterans with diabetes, 26.8% were VA users. The only significant difference between VA users and non-VA users was that VA users were significantly more likely to check their feet one or more times daily (75.7% vs. 68.5%, P = 0.015). In final adjusted models, VA users were at least twice as likely as non-VA users to have foot exams by a provider (odds ratio 2.59) and receive flu and pneumonia shots (odds ratio 2.30 and 2.05, respectively). VA users were also more likely to have two or more provider visits, dilated eye exams, and two or more hemoglobin A1c tests than non-VA users.
CONCLUSIONS: Key quality indicators for diabetes care were better among veterans getting some or all of their care from VA facilities, suggesting more effective care strategies. However, interventions should identify and perpetuate excellent self-care behaviors to more substantially impact adverse diabetes-related outcomes.
Author List
Lynch CP, Strom JL, Egede LEAuthor
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Cross-Sectional Studies
Diabetes Mellitus
Female
Health Care Surveys
Health Services Accessibility
Health Services Needs and Demand
Health Status
Hospitals, Veterans
Humans
Male
Middle Aged
Odds Ratio
Quality of Health Care
Regression Analysis
Self Care
United States
United States Department of Veterans Affairs
Veterans
