(28-01-06) Longitudinal changes in hemoglobin A1c reflect quality of diabetes care

NEW YORK (Reuters Health) - Quality of diabetes care can be assessed by measuring longitudinal changes in hemoglobin A1c, according to a report in the December issue of Health Services Research.

"Longitudinal methods like those we used in our study represent a different kind of information than currently monitored for quality of healthcare," Dr. Monika M. Safford from Birmingham VA Medical Center and The University of Alabama at Birmingham told Reuters Health. "This is more of a 'movie' than the currently widely used 'snapshot.'"
Dr. Safford and colleagues investigated the feasibility of using within-patient longitudinal changes in hemoglobin A1c as an alternative to cross-sectional measures of quality of diabetes care in 125 VA facilities nationwide.
In two different statistical models, most VA hospitals showed downward trends in within-patient hemoglobin A1c curves over time, the authors report. Only 20 facilities had monthly rises in A1c, and for all but 5, the 95% confidence interval of the slopes included zero.
The researchers were also able to use these curves to rank 105 facilities, thereby allowing an assessment of comparative performance with a selected confidence interval. There remained, however, considerable uncertainty in the rankings.
"The longitudinal approach presented here measures changes in A1c over time within individuals, effectively overcoming some of the cross-sectional problems and capturing a new domain in quality measurement," the investigators explain.
"We suggest evaluation and comparison of these within-patient change rates may prove to be a useful new approach to studying the quality of ongoing care to a population with chronic disease and may identify those facilities that could be more closely evaluated for best (and more problematic) practices," the authors conclude.
"Because this is a new approach in this field, like all new research, it should be confirmed prior to implementation," Dr. Safford added. "Nevertheless, longitudinal methods are likely to be taken up in some form as the quality-of-healthcare field continues to evolve."

Source : Health Services Research 2005;40:1818-1835.

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