Our Measures - Nationally Endorsed, Locally Vetted

This first report includes nine nationally endorsed clinical measures for people with diabetes. We distinguish measures, such as tests to be monitored, from standards, which are the desired frequency or target results of those tests. The nine clinical measures include many of the most important and evidence-based indicators of care processes and outcomes in diabetes, as endorsed by the National Quality Forum1 (NQF) the American Diabetes Association2 (ADA), the National Committee on Quality Assurance3 (NCQA), and the Veterans Affairs Administration-Department of Defense4 (VHA-DOD).

To select our measures, our Clinical Advisory Committee received and approved recommendations of its Diabetes Subcommittee, which reviewed the research literature and the recommendations of these and other national organizations.

Process of Care Measures

Our four process of care measures include actions that the physician should take to properly measure, monitor, or manage diabetes or prevent its complications.

These include:

• 1) Testing for blood sugar control using the “hemoglobin A1c” blood test;
• 2) Testing the urine for kidney problems (measuring the urine “microalbumin” level) or treating with “ACE” inhibitor or “ARB” drugs to prevent progression of kidney problems;
• 3) Referring the patient to an ophthalmologist or optometrist for an eye examination to detect early and treatable diabetic eye disease, with a kept appointment by the patient; and
• 4) Providing a pneumonia (“pneumococcal”) vaccination to avoid preventable lung infections to which patients with diabetes are especially susceptible.

Standards for these four process measures are reported individually and as a summary (or “composite”) process score within each practice and for the region as a whole.

Outcome Measures

Our five outcome measures include the results of blood tests, physical examination findings, and behavior associated with the occurrence of diabetic complications. These measures are sometimes called “intermediate outcomes” or “risk factors”, since they are not medical outcomes per se – such as diabetes-related blindness, kidney failure, or leg amputation – but their results predict these outcomes, with better results lowering the risk, and poorer results raising the risk. For simplicity’s sake, we will refer to these measures as outcomes.

Good results on these outcome measures require active patient involvement in her own self-care in addition to good treatment by the doctor.

Our five outcome measures include:

• 1) Good results of tests for blood sugar control, measured by the “Hemoglobin A1c” (or more simply, “A1c”) value;
• 2) Good results on blood tests for “bad” (LDL) cholesterol or treatment with cholesterol-lowering “statin” medications;
• 3) Good blood pressure levels;
• 4) Good weight control, measured by the “body mass index”; and
• 5) Avoidance of cigarette smoking.

As with our process of care measures, standards for these five outcome measures also are reported individually and as a summary score within each practice and across the region.