Resumen de A Clinical Action Measure to Assess Glycemic Management in the 65-74 Year Old Veteran Population
Orysya Soroka, Chin-Lin Tseng, Mangala Rajan, Miriam Maney, Leonard M. Pogach
Objectives: To evaluate the effect of including of clinical actions within 6 months of a glycosylated hemoglobin (HbA1c) level greater than 8% upon measure adherence (pass rates) and to assess the association between patient factors and the likelihood of not passing.
Setting: Veterans Health Administration.
Design: Retrospective cohort study for FY2002 to FY2004.
Participants: One hundred fifty-three thousand one hundred thirty-two veterans aged 65¿74 with diabetes mellitus not taking insulin; 99% were male and 86% white.
Measurements: The clinical action measure included three categories: (a) initial pass (index HbA1c < 8%); (b) modified pass (index HbA1c ? 8%), and the hierarchical occurrence of one of the following events within 6 months after date of index HbA1c: subsequent HbA1c < 8%, being started on insulin (100% weight), new oral medication (50% weight), care in a diabetes mellitus¿related clinic (25% weight); and (c) failure (no category met or HbA1c > 9%). Multinomial logistic regression models were used to evaluate associations between participant factors and the likelihood of not passing initially.
Results: Most (82.6%) or the participants had an index HbA1c of less than 8%, and 10.6% were in the modified pass group. The failure rate (17.4%) fell to 6.8% when actions were weighted equally and to 9.4% using different weights. Veterans who are African American (odds ratios (ORs) = 1.43 and 1.44), unmarried (ORs = 1.19 and 1.24), poor (ORs = 1.36 and 1.17), or taking two or more oral antihyperglycemic agents (ORs = 2.61 and 3.72) were significantly more likely to be in the modified pass and failure groups, respectively.
Conclusion: Most veterans with an initial HbA1c of 8% or greater had clinical actions within 6 months. A measure that incorporates multiple treatment options, including education and nutrition, could be of benefit by encouraging dialogue of such options between patients and clinicians.
