• Marcia M Ward, Jon W Yankey, Thomas E Vaughn, Bonnie J BootsMiller, Stephen D Flach, Karl F Welke, Jane F Pendergast, Jonathan Perlin, and Bradley N Doebbeling.
• Department of Health Management and Policy, University of Iowa, Iowa City, Iowa 52242-1008, USA. marcia-m-ward@uiowa.edu
• Med Care. 2004 Sep 1; 42 (9): 840-50.

BackgroundOptimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes.PurposeTo explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes.DesignSecondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers.SampleWe sampled 109 Veterans Affairs medical centers (VAMCs).ResultsAnalyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients.ConclusionsHealthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.

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