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Quality of Diabetes Care in a US Manufacturing Cohort: A Comparison of Quality Indicators as Predictors of Diabetes Complications

Bayer, Felicia J (2011) Quality of Diabetes Care in a US Manufacturing Cohort: A Comparison of Quality Indicators as Predictors of Diabetes Complications. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This study examines three process measures of diabetic care and their association with four complications of diabetes - Coronary Artery Disease (CAD), Heart Failure (HF), Stroke and Renal Disease (RD) - in a cohort comprised of hourly and salaried employees of a single large manufacturing company at geographically diverse regions in the United States. Quality of care was measured by adherence to consensus standards for A1C and lipid testing and screening for microalbuminuria. A retrospective cohort study was conducted from January 1, 2003 to December 31, 2009 of 1,797 diabetic employees of a US manufacturer who were enrolled in the same health insurance plan. Diabetics who received all three QOCM in the baseline year were compared to diabetics who received less than three QOCM in the baseline year and were analyzed to address their association with the four complications. Cox proportional hazard regression models were used to assess potential associations between diabetes QOCM and time to complication. Potential confounding risk factors included sex, age, ethnicity, income, marital status, education, smoking, diabetes severity and health comorbidity risk scores. The overall health benefits for diabetics who received all three QOCM at baseline were noteworthy; they experienced reduced risk for HF (HR 0.39, CI [.19 - .81], p = 0.0117) and RD (HR 0.48, CI [.24 - .95] p = 0.0339) compared to the people who received less than three QOCM. Results suggest that diabetics who received all three QOCM experienced lower complications and is associated with reduced complication risk - regardless of access to care and other factors. These results suggest that any improvement in screening is likely to reduce the risk of diabetes complications. This study contributes to the literature by examining adherence to recommended processes of care and patient complications together. The public health implications of this study can be used to inform the design or revision of disease management programs and process of care measures.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bayer, Felicia
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairGoldstein, Bernard D.bdgold@pitt.eduBDGOLD
Committee MemberYouk, Ada Oayouk@pitt.eduAYOUK
Committee MemberPitt, Bruce Rbrucep@pitt.eduBRUCEP
Committee MemberLave, Judith Rlave@pitt.eduLAVE
Committee MemberCullen, Mark
Date: 22 September 2011
Date Type: Completion
Defense Date: 31 May 2011
Approval Date: 22 September 2011
Submission Date: 9 June 2011
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Environmental and Occupational Health
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: complications; diabetes; quality of care
Other ID:, etd-06092011-174348
Date Deposited: 10 Nov 2011 19:46
Last Modified: 15 Nov 2016 13:44


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