Quality Indicators for the Management of Diabetes Mellitus for Vulnerable Older Persons

摘要

Diabetes mellitus is one of the most important causes of morbidity and mortality in the United States. It has been among the top ten causes of death for several decades, and it is the leading cause of end stage renal disease and visual loss among individuals under age 65. In 1997, diabetes was responsible for approximately 2.3 million hospital admissions, 14 million hospital days, and 70 million nursing home days. Direct medical expenditures on diabetic care were estimated at $44 million. At Northern California Kaiser, a matched cohort analysis indicated that the annual excess expenditures for diabetic patients totaled $3,500 per person. The prevalence of diabetes rises dramatically with age: More than 10% of persons over age 65 have clinical diabetes. Almost all of these older patients have type II diabetes. Elderly patients are still at risk for the long term complications of diabetes, having an approximately two-fold increased risk for myocardial infarction, stroke, and renal insufficiency, when compared with persons of the same age without diabetes. To date, there has been considerable high quality research on the prevention and management of complications of diabetes. However, most of these data are not specific to elderly patients, and none are specific to individuals age 80 or older. Thus, extrapolation of published data to the vulnerable elderly population is a major challenge for developing quality indicators for this group. A related challenge pertains to the time frame required in order to benefit from the proposed indicators. Many testing and management strategies require a minimum of two to three years (and in some cases, much longer) in order to accrue significant benefits. Therefore, except where noted, all of the quality indicators in this paper are intended for persons who have a life expectancy of at least two to three years.