Measuring the quality of diabetes care in urban and rural Indian health programs.

OBJECTIVE The purpose of this study was to compare the quality of diabetes care provided to American Indians/Alaska Natives (AI/AN) by urban and rural Indian health programs. DESIGN Medical record review data collected by the Indian Health Service as part of the Diabetes Care and Outcomes Audit in 2002. SETTING Seventeen urban Indian health clinics and 225 rural Indian health programs. PATIENTS All urban AI/AN patients (n = 710) and random sample records of rural AI/AN patients (n=1420). MAIN OUTCOMES MEASURES Adherence to guidelines for process measures and intermediate outcomes of diabetes care. RESULTS Compared to the rural sample, urban patients were more likely to have received diabetes education during the prior year (P < or = .05). Annual dental examinations were less common among urban patients than rural patients (19% vs 41%, P < or = .001). Completion of laboratory testing and immunizations were similar in both groups. Adjusted mean levels for intermediate outcomes of diabetes care and the percentage achieving recommended levels varied slightly but were not statistically or clinically significant. CONCLUSIONS Few differences in the quality of diabetes care were found between urban and rural Indian health sites. Differences in the receipt of dental examinations may reflect differences in resources and staffing between urban and rural settings. This study serves as a baseline for the assessment of ongoing interventions aimed at improving the quality of care.