The Relationship of Diabetes Mellitus Performance Indicators with Self-Reported Health and Patient Satisfaction
David P. Nau
Ritesh N. Kumar
Introduction: Disease management programs often strive to enhance patient outcomes through improvements in the process of care. The purpose of this study was to determine the relationship of diabetes care process measures with self-rated health and patient satisfaction among managed care patients with diabetes mellitus, while controlling for the influence of demographics, co-morbidities and severity of illness. Study design and methods: This study was an integrated analysis of cross-sectional survey and retrospective claims data. The sample included 300 adult patients with diabetes mellitus enrolled in an Independent Practice Association-model health maintenance organization. Analyses consisted of two multiple regression models with self-rated health (100-point scale, higher score = better health) and patient satisfaction (9-point scale, higher score = greater satisfaction) being the dependent variables, respectively. Predictor variables in both models included: demographics (age, gender, education, income), severity of illness (insulin use, duration of diabetes mellitus), number of co-morbidities, receipt of foot and eye exams, diabetes mellitus education, lipid tests, microalbumin tests, frequency of self-monitoring of blood glucose and the frequency of tests for glycosylated hemoglobin (HbA1c) and blood glucose. Results: Mean (SD) for self-rated health and patient satisfaction scores were 49.8 (25.0) and 7.8 (1.8), respectively. The squared multiple regression coefficients (R2) for model 1 (self-rated health) and model 2 (patient satisfaction) were 0.20 and 0.10, respectively. Significant predictors of self-rated health included co-morbidities (standardized regression coefficient [beta] = -0.12), income (beta = 0.27), and HbA1c tests (beta = 0.19). Significant predictors of patient satisfaction included co-morbidities (beta = -0.16), foot exams (beta = 0.16), and diabetes mellitus education (beta = 0.16). Conclusion: When controlling for demographics, co-morbidities and severity of illness, those patients who received more frequent HbA1c monitoring reported better health, and patients who received foot exams and diabetes education were more satisfied with the care they received for diabetes mellitus. Thus, disease management initiatives that optimize the education and monitoring of patients with diabetes mellitus are likely to produce better patient-reported outcomes.
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