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PATIENT EXPERIENCE WITH CARE AND CLINICAL OUTCOMES IN DIABETES: A CASE FOR MORE PERSON-CENTERED MEASUREMENT
Abstract
Rationale, aims and objectives: Diabetes performance metrics are widely used to assess care, inform the public, guide reimbursement, and facilitate quality improvement efforts. The most common, the D5, is a composite process and intermediate outcome measure that may not capture key patient-important outcomes. This study assesses the ability of the D5 and the Patient Assessment of Chronic Illness Care (PACIC) instrument to evaluate patient experience with care.
Method: Postal surveys with the PACIC instrument, and questions about demographics, health status, and self-efficacy were mailed to 4796 adults from a diabetes registry maintained by 34 primary care clinics in November 2009. D5 measures for 2009 (glycosylated hemoglobin <8%, blood pressure <140/90 mmHg, low density lipoprotein cholesterol <100 mg/dL (2.59 mmol/L), non-smoking, aspirin therapy) were obtained from electronic medical records. Logistic regression analysis evaluated the association of PACIC, self-reported health, demographics, and D5.
Results: The 2055 (42.8%) respondents had mean age 64.9 years (standard deviation (SD), 12.3), HbA1c 6.9% (SD, 1.2%), and PACIC 3.0 (SD, 1.1); 43.8% achieved the D5. Self-reported diabetes control and lack of perceived financial barriers to medical care were associated with achieving the D5; however, PACIC and other patient-reported measures of health were not associated with achieving the D5. In contrast, diabetes self-management education, social support network, and self-efficacy were associated with higher PACIC scores.
Conclusions: Efforts to improve patient-centered care necessitates the assessment of patient experience of health and healthcare. The PACIC may be an important adjunct to the D5 to measure the quality of diabetes care.
Keywords
References
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DOI: http://dx.doi.org/10.5750/ejpch.v3i2.911
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