Diabetes Preventive Care and Nontraumatic Lower Extremity Amputation Rates

~ Exam ~

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By participating in this independent study offering, the reader will be able to do the following:

  1. Summarize the benefits of measuring clinical performance in a health system for diabetes as well as other chronic conditions.
  2. Describe how preventive care for diabetes could potentially lead to improved health outcomes.
  3. Outline a study to demonstrate the association between processes of care for diabetes and diabetes-related patient outcomes.
1. What is considered the key reason lower extremity amputation rates might be higher in patients with diabetes compared to the general population?
  a. Patients with diabetes are more likely to smoke than the general population.
  b. Patients with diabetes are more vulnerable to ulcers because they cannot sense skin trauma.
  c. Patients with diabetes are less vulnerable to neuropathy than the general population.
  d. Patients with diabetes are less likely to see the physician.
2. Which process measures can be used to monitor the quality of healthcare specific to diabetes?
  a. pedal pulse and foot sensory examination
  b. foot sensory examination and influenza vaccinations
  c. pedal pulse only
  d. pedal pulse and TB screening
3. In the mid-1990s, which of the following best describes one of the major transformations of the Veterans Health Administration (VHA)?
  a. The VHA transformed its administration from more local control to a more centralized control infrastructure.
  b. The VHA increased resources for inpatient and specialty care.
  c. The VHA implemented clinical performance monitoring to assess costs of inpatient care.
  d. The VHA implemented clinical performance measures to assess quality of care for chronic conditions.
4. What is the key benefit of clinical performance monitoring in the VHA?
  a. Profiling patients on their compliance with treatment can help improve their adherence to prescribed medical regimens.
  b. Refining the resource-based relative value scale used in the VHA in order to recoup healthcare costs.
  c. Monitoring and comparing the quality of healthcare across facilities in order to benchmark continuous quality improvement.
  d. Profiling provider performance can be used to identify the best performing providers who can implement quality improvement programs at rural facilities.
5. Which of the following best describes one of the key limitations of clinical performance monitoring via chart reviews in the VHA?
  a. Clinical data from chart reviews are not as detailed as clinical data from claims data.
  b. Chart reviews are based on secondary (previously recorded) data and not on primary data collection.
  c. Clinical information from VHA chart reviews were not available until fiscal year 2002.
  d. Chart reviews do not contain data on diabetes treatment.
6. Based on information given in this article, which of the following statements regarding quality of healthcare and performance monitoring is not true?
  a. Profiling the quality of care at the VHA network or medical center levels is a potentially less obtrusive method for monitoring continuous quality improvement than profiling quality of care at the provider level.
  b. Profiling providers on quality of care for diabetes and other chronic conditions is the only method that can be used to improve quality of care in the VHA.
  c. In the VHA, the greatest amount of practice variation in quality of care measures for diabetes is potentially occurring at the VHA medical center level and not at the provider level.
  d. A recent Institute of Medicine report concluded that changes at the healthcare system level are needed to improve the overall quality of care for patients.
7. Which of the following was considered acceptable documentation of a foot examination according to the VHA external peer review program chart review?
  a. documentation of whether sensation was tested
  b. referral to a podiatrist
  c. documentation of a drawing of the patient’s foot
  d. documentation of visual examination of the foot
8. Which of the following statements most accurately reflects the results reported in this study?
  a. Statistically significant associations were found between lower rates of sensory and pedal pulse examinations in FY00 and lower FY01 lower extremity amputation (LEA) rates.
  b. Statistically significant associations were found between higher rates of sensory and pedal pulse examinations in FY00 and lower FY01 LEA rates.
  c. Statistically significant associations were found between higher rates of sensory examinations and higher FY01 LEA rates.
  d. There was no correlation between sensory and pedal pulse examinations and LEA rates.
9. Which of the following was not considered a limitation of this study?
  a. Data were not analyzed at the individual patient level.
  b. Data do not control for structural factors such as academic affiliation status.
  c. Data were not generalizable to the veteran population in the United States.
  d. Patient-level data on diabetic neuropathy or glycemic control were not assessed.
10. In designing a study in the VHA, to demonstrate the association between processes of care for diabetes and diabetes-related patient outcomes based on secondary data (i.e., data already collected), which of the following should be considered as potential sources of study data?
  a. aggregate cost data and chart review data
  b. chart review data only
  c. claims data only
  d. both chart review data and medical administrative (claims) data