Abstract 15: Assessing Clinical Quality Indicators for Diabetes Care by Patient Home Zip Code

Objective: Quality of care for diabetes varies widely in the United States but is usually compared at the level of health facilities. As part of the HealthRise project, we analyzed ambulatory clinic data at the level of each patient’s residential zip code to determine whether achievement of risk factor targets is also a function of home neighborhood. Methods: Minnesota Community Measurement (MNCM) collects comprehensive patient-level clinical data from all non-federal ambulatory clinics in their state. Using MNCM data from the year 2013, we assessed risk factor targets for diabetes, defined as the percentage of adult diabetics seen at least twice in 12 months who achieved all of four risk factor targets (HbA1c < 8%, LDL<100 mg/dL, systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg, and documented to be free of tobacco use). We aggregated the data to the zip code in which the patient resided for Hennepin, Ramsey, and Rice Counties, representing Minneapolis-St. Paul and a nearby rural county. Results: Success in meeting the HbA1c target was similar between counties, with 74.1% of patients in Hennepin, 74.4% in Ramsey, and 76.2% in Rice meeting the target. However, this varied widely at the zip code level. Across zip codes, the HbA1c target was achieved by 58.8% to 90.0% of patients and the LDL target by 46.7% to 83.6% of patients. Blood pressure and tobacco use targets were met by more patients (74.4% to 95.3% for blood pressure and 70.2% to 94.6% for tobacco). The lowest-performing zip codes were consistent across all four targets. Populations with the lowest achievement levels were found in the neighborhoods of North Minneapolis and Camden in Hennepin County, Downtown St. Paul, Southwest Downtown St. Paul, and South East Downton St. Paul in Ramsay County, and outlying rural areas in Rice County. Conclusion: Small-area geographies based on residential zip code appear to stratify the achievement of risk factor targets for diabetic patients in Hennepin, Ramsey and Rice Counties. Patients living in socioeconomically disadvantaged areas are less likely to achieve these clinical targets. Policies to improve cardiovascular risk factor control within clinics should also consider expanding their data collection to include the role of patients’ neighborhood environment. ![][1] [1]: /embed/graphic-1.gif