8.  QUALITY ASSESSMENT OF DIABETES CARE, FY2007 ITEM DESCRIPTION

For the purposes of this audit, a VISIT is defined as any primary care visit, including ER and walk-in clinics. Do not include dental, eye care, patient education, surgery clinics, etc.

AUDIT DATE, CHART NUMBER, DATE OF BIRTH, SEX: Self-explanatory.

FACILITY NAME: Enter your facility's name or abbreviation.

AREA, SERVICE UNIT and FACILITY codes: use the 2-digit official IHS codes ("ASUFAC" codes). Contact your Area diabetes consultant if you are unsure about your correct ASUFAC numbers.

DOES LOCAL COMMUNITY RECEIVE SPDI GRANT FUNDS?  (1) Yes  (2) No or (3) Don't know.
If "Yes", record the official SDPI grant number (for example, H1D01234-06) in the designated space.

TRIBAL AFFILIATION: Enter the 3 digit Tribal code.

COMMUNITY: Enter the 7 digit code for the patient's community of residence.

# OF PTS IN DIABETES REGISTRY: Enter the number of active patients in your diabetes register. If your service unit has multiple facilities participating in the audit, make sure you use the correct sample size (number of active DM patients) for each component. [This is a very important item! Please take care to assure accuracy.]

DATE of Diabetes Diagnosis: If only the year of diagnosis is stated, enter "07/01" of that year. If only the month and year are stated, enter the 15th of that month. Leave blank if date is unknown.

TYPE of Diabetes: Specify if the patient has (1) Type 1 (a.k.a. IDDM, juvenile onset diabetes), or (2) Type 2 (a.k.a. NIDDM, adult-onset diabetes). Keep in mind that not all insulin-using patients have type 1 diabetes - in fact, most of them have type 2 diabetes. If uncertain, mark as (2) Type 2.

TOBACCO USE: Current status of tobacco use (cigarettes, chewing tobacco, snuff, etc) taken from the health summary, problem list or flow sheet. Mark (1) Currently uses tobacco, (2) Does not currently use tobacco, or (3) Tobacco use undocumented.

Referred for cessation counseling? [to be completed only if currently uses tobacco]. (1) Yes, if provider documents cessation counseling or referral for cessation counseling during the past 12 mo. (2) No, if no cessation counseling in past year, or (3) Refused, if documented that patient declines/refuses cessation counseling efforts.

HEIGHT: Enter height in inches, or in feet and inches.

LAST RECORDED WT: Record in pounds. If pregnant, use last non-pregnant weight. A note to re-confirm the value appears during data entry if an adult weight is <60 lbs or >600 lbs.

HTN documented (DX or RX): (1) Yes, hypertension diagnosis is on the problem list or visit assessment, or medication for hypertension is prescribed. (2) No documented hypertension diagnosis or meds.

Last 3 BLOOD PRESSURES: Record the last 3 blood pressures obtained within the last year. If a value falls outside of the expected range (e.g., >240 systolic or >140 diastolic) it will not be accepted; a cautionary note to confirm the level appears if systolic BP is >210 or diastolic BP is >130.

FOOT EXAM: Exam must include evaluation of sensation and vascular status.

EYE EXAM: Exam must include a dilated eye exam or stereo fundus photographs.

DENTAL EXAM: Must include examination of the gingiva and mucosal surfaces. Dental records may be kept separate from medical records at your facility.

EDUCATION in past year
From flow sheets, progress notes, PHN referral or consults.

DIET INSTRUCTION: Note any mention of diet instruction in the past year and code by provider type: (1) Registered dietitian, (2) Non-R.D., (3) Both, or (4) None. If it is documented that pt. refused diet counseling, select (5) Refused.

EXERCISE INSTRUCTION: Note any mention of exercise instruction in the past year.

Any GENERAL DM EDUCATION: Note any recorded patient education in the past year on any topic(s) related to diabetes, other than diet or exercise.

DM THERAPY: Enter a 1 (Yes) or 2 (No) for each of the following therapy groups:
(1) Diet & Exercise Alone
(2) Insulin (all forms, including insulin aspart (NovoLog), lispro (Humalog) and glargine (Lantus))
(3) Sulfonylureas, including the following:

(4) Metformin (Glucophage) Note: Select choices 3 and 4 for Glucovance (glyburide + metformin)
(5) Acarbose (Precose) or miglitol (Glyset)
(6) Glitazones, including pioglitazone (Actos) or rosiglitazone (Avandia)
(9) Refuses therapy, or unknown.

ACE INHIBITOR/ARB* use:
(1) Currently uses (is prescribed) an ACE inhibitor/ARB,
(2) does not currently use an ACE inhibitor/ARB, or
(3) Refused ACE inhibitor/ARB therapy.
*Both ACE inhibitors and angiotensin II receptor blockers (ARBs) are included here.

Examples of ACE inhibitor drugs include:

Examples of angiotensin II receptor blockers (ARBs) include:

If unsure, check with your pharmacist regarding the ACE inhibitors and angiotensin II receptor blockers used at your facility.

ANTIPLATELET Therapy: (1) Currently uses (is prescribed) chronic aspirin or other antiplatelet/anticoagulant medication, including:

(2)  Is not on chronic aspirin or other antiplatelet/anticoagulant therapy, or (3) Refused antiplatelet therapy.

LIPID LOWERING AGENT* use:
(1) Currently uses (is prescribed) a "statin" lipid lowering agent, including any of the following:

(2) Currently uses (is prescribed) another class of lipid lowering agent, including any of the following:

(3) Currently uses both a "statin" and any other type of lipid lowering agent, (4) Is not currently on a lipid lowering agent, or (5) Refused lipid lowering therapy or had an adverse reaction.

FLU VACCINE past year: (1) Yes, if administered in the past year. If the chart audit is conducted between September and December, give credit for an immunization administered during the previous flu season.

PNEUMOVAX ever: Self-explanatory.

Td in past 10 years: Self-explanatory.

TB Status (PPD): (1) Last PPD skin test result was positive, or patient has known history of TB, (2) Last PPD was negative, (3) Refused PPD skin testing, or (4) Unknown.

If PPD Pos, is INH Tx Complete: (1) Yes, if the patient has documentation of at least 6 months of prophylactic INH or at least 12 months of multiple drug therapy documented for active TB, (2) No, if patient has not completed therapy. Include individuals for whom INH therapy was contraindicated. (3) Refused, if the patient declined therapy. (4) Unknown treatment status.

If PPD Neg, Date of last negative PPD: Self-explanatory.

DATE OF LAST ECG: Self-explanatory. Leave blank if no EKG has ever been recorded.

Hemoglobin A1c: First, record the most recent HbA1c value and the date it was drawn. Then record the next most recent HbA1c value (Note: assure that the most recent value is listed first)

CREATININE, CHOLESTEROL (TOTAL, HDL, LDL), TRIGLYCERIDES: For each test, enter most recent value in past year. If the last value is more than 12 months old, do not record it. Caution: avoid inadvertent entry of LDH value for LDL Cholesterol value.  For patients on renal dialysis, enter a creatinine value of "99.9".

URINALYSIS or Albumin/Creatinine Ratio in past 12 months: Self-explanatory.

PROTEINURIA:  (For those who had a UA or A/C ratio obtained in the past year only).  Most recent dipstick protein test showed: (1) 1+ (30 mg/dl) or more, (2) No protein (or trace only).

MICROALBUMINURIA: (For patients without dipstick proteinuria) A test for the presence of albumin in the urine was:
(1) Positive, microalbuminuria present, i.e., one of the following criteria is met:

(2) Negative: test did not show microalbuminuria
(3) Not tested or unknown.

DEPRESSION as an active problem: (1) Yes, if depression is listed on active problem list or POV,  otherwise (2) No.

DEPRESSION SCREENING in the past year:  (1) Yes, if provider used Zung, Beck, PHQ-2 or similar depression screening scale, or  otherwise documented that pt was assessed for possible depression;  2 (No) if no documentation of depression screening found; or (3) Refused.    

[OPTIONAL]

A LOCAL OPTION QUESTION, if present, will be found at the end of the audit. Read the question carefully and then select the appropriate response. (For more information on the Local Option Question, see the next section).