Assessment of diabetes care by medical record review. The Indian Health Service model

• Published in: Diabetes care Vol. 17; no. 8; pp. 918 - 923
• Main Authors: MAYFIELD, J. A, RITH-NAJARIAN, S. J, ACTON, K. J, SCHRAER, C. D, STAHN, R. M, JOHNSON, M. H, GOHDES, D
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.08.1994
• Subjects: Adolescent; Adult; Aged; Associated diseases and complications; Biological and medical sciences; Blood Glucose - analysis; Blood Pressure; Child; Delivery of Health Care - standards; Diabetes Mellitus - physiopathology; Diabetes Mellitus - rehabilitation; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Diabetic Foot - diagnosis; Diabetic Foot - prevention & control; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - prevention & control; Diet, Diabetic; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Male; Medical Records - standards; Medical sciences; Middle Aged; National Institutes of Health (U.S.); United States; United States Indian Health Service; Asia; India; United States; Endocrinopathy; Human; Surveillance; Primary health care; Diabetes mellitus; Professional practice; Quality control; Physician; Complication; Medical screening; Statistical study; Recommendation
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.17.8.918

Assessment of diabetes care by medical record review. The Indian Health Service model. J A Mayfield , S J Rith-Najarian , K J Acton , C D Schraer , R M Stahn , M H Johnson and D Gohdes Department of Family Medicine, Bowen Research Center, Indiana University, Indianapolis 46202. Abstract OBJECTIVE--To evaluate the adherence to minimum standards for diabetes care in multiple primary-care facilities using a uniform system of medical record review. RESEARCH DESIGN AND METHODS--In 1986, the Indian Health Service (IHS) developed diabetes care standards and an assessment process to evaluate adherence to those standards using medical record review. We review our assessment method and results for 1992. Charts were selected in a systematic random fashion from 138 participating facilities. Trained professional staff reviewed patient charts, using a uniform set of definitions. A weighted rate of adherence was constructed for each item. RESULTS--Medical record reviews were conducted on 6,959 charts selected from 40,118 diabetic patients. High rates of adherence (> 70%) were noted for blood pressure and weight measurements at each visit, blood sugar determinations at each visit, annual laboratory screening tests, electrocardiogram at baseline, and adult immunizations. Lower rates of adherence (< or = 50%) were noted for annual eye, foot, and dental examinations. CONCLUSIONS--IHS rates of adherence are similar to rates obtained from medical record reviews and computerized billing data, but are less than rates obtained by provider self-report. Medical record review, using uniform definitions and inexpensive software for data entry and reports, can easily be implemented in multiple primary-care settings. Uniformity of data definition and collection facilitates the aggregation of the data and comparison over time and among facilities. This medical record review system, although labor intensive, can be easily adopted in a variety of primary-care settings for quality improvement activities, program planning, and evaluation.