Viion lo among diabetic in a group model health maintenance organization (HMO)

PURPOE : To report the management of diabetic retinopathy in one group model health maintenance organization and ae the quality of care. METHOD : Cro-ectional tudy. A chart review of 1200 randomly identified patient with diabete mellitu, continuouly enrolled for 3 year in Kaier Permanente (KP) outhern California, the larget provider of managed care in outhern California, wa performed. A total of 1047 patient were included in the analye. Patient characteritic a well a information from the lat eye examination were abtracted. Chart from patient with viual acuity le than 20/200 in their better eye (legal blindne) were elected for extenive chart review to determine the caue of viual lo and the antecedent proce of care. T tet or the Wilcoxon rank um tet wa ued to compare continuou variable. The χ2 tet or the Fiher exact tet wa ued to compare categorical variable. All analye were performed on the tatitical Analye ytem (A Intitute, North Carolina). REULT : Our tudy population of 1047 diabetic patient wa 51.7% male, had a mean age of 60.4 year, a mean duration of diabete of 9.6 year, and a mean hemoglobin A1c of 8.3%. During the tudy period, 77.5% of patient received a creening eye examination with examination by an ophthalmologit, an optometrit, or review of a retinal photograph. Of thoe with a viual acuity aement (n = 687, 65.6% of 1047), 1.5% had viual acuity of 20/200 or wore (legally blind) in the better eye, while 8.2% had thi level of viual acuity in the wore eye. Of eye with new onet clinically ignificant macular edema and viual acuity < 20/40, 40% had documentation of focal laer performed within 1 month of diagnoi. Of eye with vitreou hemorrhage and viual acuity < 20/40, 50% had documentation of vitrectomy. Among eye that had vitrectomy, over 80% had thi procedure within 1 year of diagnoi of vitreou hemorrhage. CONCLUION : The current report i the larget tudy of diabetic retinopathy outcome among patient enrolled in a prepaid health plan. Further reearch i neceary to invetigate the impact of managed care on health outcome.