Characteristics associated with glycemic control among family medicine patients with type 2 diabetes.

345 D is currently the seventh leading cause of death in the United States, as revealed in data from 2007 on US death rates [1]. The incidence of this metabolic disease state is increasing at an epidemic frequency, and it is projected that if the incidence continues to increase, 1 in 3 Americans born in 2000 will have received a diagnosis of diabetes by 2050 [2]. Multiple organizations have put forth recommendations for diabetes-associated quality of care measures [3, 4]. The outcomes related to process-of-care measures among persons with diabetes have been evaluated in several studies, and findings indicate that overall goals are not being met and that disparities exist in the control of hemoglobin A1c (A1c) levels among minority populations [5, 6]. Despite the availability of evidence-based guidelines and vast knowledge about microvascular and macrovascular complications due to this disease, clinical goals for diabetes outcomes are not being routinely achieved in practice. As health care reform moves forward, there is pressure to develop new payment systems that reward clinicians for achieving certain quality-of-care markers. If clinicians are to be held accountable for helping their patients with diabetes achieve quality outcomes, they need information on patient characteristics associated with reaching these clinical goals. Otherwise, there is no way to appropriately adjust for a clinician’s case mix of factors, which are out of their control but impact a patient’s ability to reach the targets. For instance, if income has a large impact on a patient’s ability to reach certain goals, this needs to be considered before holding the clinician accountable for the patient’s clinical outcomes. Information on these factors can lead to identification of patients who may have more difficulty managing their disease and can be helpful in the targeted use of limited resources. The current study uses the determinants-ofhealth framework to analyze outcomes for persons with type 2 diabetes. The determinants-of-health model states that health is not simply related to the medical care an individual receives but is also impacted by genetics, environment, and lifestyle. A large body of work has used this framework to look at population health outcomes [7-11]. These studies have included determinants such as income level, education level, and unemployment. Models that help predict outcomes of chronic illnesses such as diabetes should include patient-reported variables and their relationship to successful outcomes. Investigations that aid in understanding patient-specific determinants that contribute to an indiCharacteristics Associated With Glycemic Control Among Family Medicine Patients With Type 2 Diabetes