Diabetes

Diabetes (also called diabetes mellitus) is a condition in which a person has high blood sugar (glucose) because their body does not produce enough insulin, or because their cells do not properly respond to the insulin that is produced. Without insulin, the blood cannot absorb sugar, which is an important source of energy for the brain, muscles, and other tissues.

People with diabetes are at risk for long-term complications, which develop gradually. The longer a person has diabetes and the less their blood sugar is controlled, the higher the risk of complications. The excess sugar causes injury to small blood vessels. Possible complications include cardiovascular disease, stroke, eye disease, kidney failure, nerve damage and amputations. Controlling blood sugar, blood pressure and cholesterol - and medical attention for possible kidney failure - are essential and can decrease the risk of developing these complications.

At the University of Michigan Health System, we evaluate the care that diabetes patients receive during routine visits to their physicians. In evaluating our performance, it is important to consider two types of measures, adherence to best practices (or care process) and the success (or outcome) of care.

The Healthcare Effectiveness Data and Information Set (HEDIS) provides national benchmarks for some measures of performance. For measures where there is no national benchmark, we monitor our progress toward goals that we have established to ensure that we are providing the best care. The graphs show that for most, but not all measures, we have met or exceeded HEDIS benchmarks or our quality goals for the care we deliver to our diabetes patients.

The following graphs describe the performance of the University of Michigan Health System by measuring the extent to which we follow best practices when caring for patients with diabetes. These best practices are also called evidence-based processes of care. When followed, they lead to better outcomes and fewer complications.

Testing Blood Sugar
Higher Value = Better Performance

Details

Why is This Measure Important?

The hemoglobin A1c (HbA1c) test is used to measure a patient's average blood sugar (glucose) level over a 3-month period. Good blood glucose control is important to prevent long-term complications from diabetes. This test should be performed at least once a year, and more often if necessary for some patients, to help monitor progress. This is a measure of the percentage of diabetes patients who receive at least one HbA1c test in a year. A higher percentage means better performance.

How is UMHS Performing?

At the University of Michigan Health System, the percentage of patients with diabetes who receive HbA1c testing is consistently above 90% and has always been at or above the Healthcare Effectiveness Data and Information Set (HEDIS) benchmark. Several efforts are underway to improve this measure, including distribution of reports to physicians that identify patients who are due for an HbA1c test at the time of their visit and patient reminder letters and calls.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Healthcare Effectiveness Data and Information Set (HEDIS) Quality Compass 90th percentile (all lines of business).

Use of Statin Medications
Higher Value = Better Performance

Details

Why is This Measure Important?

Patients with diabetes are at increased risk for heart disease. They can decrease their chance of having a heart attack or dying from a heart attack by keeping their “bad” cholesterol (Low Density Lipoprotein or LDLC) levels under control. Statins are popular cholesterol-lowering medications that can help patients achieve their goal of keeping LDLC at less than 100. This is a measure of the percentage of diabetes patients with an LDLC higher than 100 who receive a statin medication. A higher percentage means better performance.

How is UMHS Performing?

The University of Michigan Health System is performing well in this measure, with our most recent rate at 93%. There is no benchmark comparison. Instead we have established a goal of 95%, which we are working to achieve. To continue improving, we are regularly identifying patients who are above the LDLC goal and may be considered for a statin. At some clinics, clinical pharmacists are contacting patients to discuss the benefits of a statin medication and start them on it if appropriate.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Institutional goal set by UMHS.

Performing Eye Exams
Higher Value = Better Performance

Details

Why is This Measure Important?

Patients with diabetes, especially those with poorly controlled blood sugar levels, are at increased risk for damage to the nerve endings in the eyes. Therefore, it is important for diabetic patients to have their eyes examined regularly to detect any damage early in order to prevent blindness. This is a measure of the percentage of diabetes patients who received an eye exam within the past two years. A higher percentage means better performance.

How is UMHS Performing?

The University of Michigan Health System is performing well in this measure, with significant improvements over the years. We are above the HEDIS benchmark for this measure. Ongoing efforts are in place to continue the improvement and include identifying and contacting patients who are due for eye exams.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Healthcare Effectiveness Data and Information Set (HEDIS) Quality Compass 90th percentile (all lines of business).

Monitoring Kidney Function
Higher Value = Better Performance

Details

Why is This Measure Important?

Patient with diabetes, especially those with poorly controlled blood sugar levels, are at increased risk for developing kidney damage. It is important to monitor and treat any kidney damage early to prevent kidney failure. A simple urine test may be used to see if there is too much protein in your urine, which may indicate kidney damage. This is a measure of the percentage of diabetes patients with too much urinary protein who are being monitored or treated for kidney damage. A higher percentage means better performance.

How is UMHS Performing?

The University of Michigan Health System performance continues to be close to the Healthcare Effectiveness Data and Information Set (HEDIS) benchmarks. To continue improving our rates, several initiatives are in place, including distribution of reports to physicians that identify diabetic patients who need to be screened or monitored for kidney damage and patient reminder letters and calls.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Healthcare Effectiveness Data and Information Set (HEDIS) Quality Compass 90th percentile (all lines of business).

Performing Foot Exams
Higher Value = Better Performance

Details

Why is This Measure Important?

Patients with diabetes, especially those with poorly controlled blood sugar levels, are at increased risk for damaging the nerve endings in the feet. This can lead to loss of feeling, ulcers and infections in the feet. Therefore, it is important for diabetic patients to have their feet examined annually. This is a measure of the percentage of diabetes patients who received a foot exam within a year. A higher percentage means better performance.

How is UMHS Performing?

At the University of Michigan Health System, the proportion of patients with diabetes who had a foot exam is currently below the UMHS goal of 92%. Efforts are aimed at improving our performance with this measure. A new process is in place and is showing improvement.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Institutional goal set by UMHS.

IIn this section, we evaluate the success in managing patients with diabetes. The graphs display the percentage of patients who had good control of blood sugar, cholesterol and blood pressure. They show that the University of Michigan Health System is achieving good outcomes for blood sugar and cholesterol control and is improving outcomes for blood pressure.

Controlling Blood Sugar
Higher Value = Better Performance

Details

Why is This Measure Important?

The hemoglobin A1c (HbA1c) test is a measure of the patient's average blood sugar level over a 3-month period. Patients with HbA1c levels greater than 9% are considered to be poorly controlled and are at greater risk for developing long-term complications of diabetes. This is a measure of the percentage of diabetes patients with HbA1c equal to or less than 9%. A higher percentage means better performance.

How is UMHS Performing?

The proportion of diabetic patients with hemoglobin A1c less than or equal to 9% is now 82% which is equal to the Healthcare Effectiveness Data and Information Set (HEDIS) benchmark of 79%. Several initiatives are ongoing to improve this measure, including outreach and frequent follow-up of patients with high HbA1c levels by clinical pharmacists or nurses in between physician visits.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Healthcare Effectiveness Data and Information Set (HEDIS) Quality Compass 90th percentile (all lines of business).

Controlling Blood Pressure
Higher Value = Better Performance

Details

Why is This Measure Important?

High blood pressure increases the risk of heart attacks, especially in patients with diabetes. It is important to maintain blood pressure levels less than 140/90. This is a measure of the percentage of diabetes patients with blood pressure less than 140/90. A higher percentage means better performance.

How is UMHS Performing?

At the University of Michigan Health System, the percentage of patients with blood pressure under 140/90 is at 74% which is below the Healthcare Effectiveness Data and Information Set (HEDIS) benchmark of 76%. To continue improving, we regularly identify patients who are above the blood pressure goal and may benefit from further medication therapy.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Healthcare Effectiveness Data and Information Set (HEDIS) Quality Compass 90th percentile (all lines of business).