Goal for clinical practiceTarget for performance measurementComment
Adequacy of Glycemic Control“good control”: HbA1c ≤ 7.0% ADA1 Proportion of patients with “poor control”:
  • HbA1c ≥ 9% NDQIA2
  • HbA1c ≥ 9.5%)3
Many factors effect the appropriateness of HbA1c < 7% as a fixed goal for a clinic or health care system to achieve (e.g., frequency of hypoglycemia, comorbid conditions, patient preferences), hence the focus on percentage of patients with “poor control” (≥ 9%) for purposes of performance measurement
Blood pressure control< 130/80 mmHg≤ 140/90 mmHgSimilarly, system-wide reports of BP control focus on percentage of patients with poor control (≥ 140/90 mmHg)
Lipid controlLDL-C ≤ 100 mg/dl (2.6 mmol/l)LDL-C ≤ 130 mg/dlElevated LDL-cholesterol is most strongly correlated with increased risk of cardiovascular disease. Again, optimal goal of 100 mg/dl may not be attainable for numerous reasons.
Triglycerides ≤ 150 mg/dl (1.7 mmol/l)
HDL ≤ 40 mg/dl (1.1 mmol/l)
Frequency of assessing HbA1c ≥ 2 times/year for patients meeting treatment goals;1 ≥ 1 HbA1c test/year (NDQIA,2 HEDIS® 3)Yearly measurements of HbA1c are correlated with actual lower HbA1c levels.
≥ 4 times/year patients not meeting treatment goals1
Frequency of assessing lipids> 1 complete lipid panel/year1 ≥ 1 LDL-C measurement/year (NDQIA,2 HEDIS3)
Urine protein screening≥1 test for urine microalbumin/year1 ≥ 1 test for urine microalbumin/year(NDQIA,2 HEDIS3)Receives only an “E” recommendation from ADA (“Expert consensus or clinical practice”) for type 2 diabetic patients.
Eye examination≥1 dilated retinal examination/year1 ≥ 1 dilated retinal examination/year (or every other year if low risk)“Low risk”: non-insulin-requiring, HbA1c < 8%, no prior evidence of retinopathy
Foot examination≥ 1 complete foot exam/year (including sensory exam with microfilament)1 ≥ 1 foot examination of any kind
Smoking cessationAdvise all smokers to quit; smoking cessation as part of routine diabetic care1 Percentage of patients whose smoking
status was ascertained and documented annually
Patient educationNo formal recommendationNo formal recommendation

ADA - American Diabetes Association; NDQIA - National Diabetes Quality Improvement Alliance; HEDIS - Health Plan Employer Data and Information Set. The HEDIS measure is actually a composite measures for “comprehensive diabetes care” consisting of the specific measurements show in the table.

From: Appendix A, Comparison of recommended goals for clinical practice vs. targets for performance measurement

Cover of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 2: Diabetes Care)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 2: Diabetes Care).
Technical Reviews, No. 9.2.
Shojania KG, Ranji SR, Shaw LK, et al.

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