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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.110478v1 AJPH.2007.110478v2 98/11/2079    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Roubideaux, Y. Articles by Acton, K. Search for Related Content PubMed PubMed Citation Articles by Roubideaux, Y. Articles by Acton, K. Related Collections Community Health Access to Care Mental Health Rural Health Socioeconomic Factors Women's Health

Yvette Roubideaux, MD, MPH, Carolyn Noonan, MS, Jack H. Goldberg, PhD, S. Lorraine Valdez, MPA, BSN, CDE, Tammy L. Brown, MPH, RD, BC-ADM, CDE, Spero M. Manson, PhD and Kelly Acton, MD, MPH

Yvette Roubideaux is with the Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson. Carolyn Noonan is with the Department of General Internal Medicine, University of Washington, Seattle. Jack H. Goldberg is with the Department of Epidemiology, University of Washington, Seattle. S. Lorraine Valdez, Tammy L. Brown, and Kelly Acton are with the Division of Diabetes Treatment and Prevention, Indian Health Service, Albuquerque, NM. Spero M. Manson is with the Department of Psychiatry, University of Colorado, Denver, and Health Sciences Center, Denver.

Correspondence: Requests for reprints should be sent to Yvette Roubideaux, MD, MPH, College of Medicine, University of Arizona, 500 N Tucson Blvd, #110, Tucson AZ 85716 (e-mail: yvetter{at}u.arizona.edu).

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care.

Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care.

Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05).

Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs.