The use of self-management skills by patients is often measured only in terms of medical outcomes. If the skills are effective, it is assumed that changes will be seen in the patient’s condition. Health policies are important determinants of clinician and patient behavior, and an important policy issue is what items are included in health care quality and performance measures. Russ Glasgow and coworkers pointed out that there is consensus that patient-centered care and self-management support are essential evidence-based components of good diabetes care. However, most major diabetes performance measures such as the National Committee for Quality Assurance (NCQA)/American Diabetes Association (ADA) Provider Recognition Program indexes have not included self-management or psychosocial items. The investigators reviewed the case for and proposed a set of patient-centered, self-management indicators to be included as a standard part of diabetes quality indicators. The proposed indicators include: (a) patient self-management goal(s); (b) measures of health behaviors (e.g., healthy eating, medication taking, physical activity, and smoking status); (c) quality of life; and (d) patient-centered collaborative care.

WHAT THE STUDY MAY MEAN TO YOU: Russ and his coworkers concluded that the adage that "what gets measured, gets done" applies to diabetes management and many other areas of health care. Inclusion of the proposed self-management indicators in national diabetes performance measures would be consistent with Institute of Medicine (IOM), ADA, Centers for Disease Control (CDC), Diabetes Attitudes, Wishes, and Needs (DAWN), AADE, and Society of Behavioral Medicine (SBM) recommendations. Such action would enhance both the priority and delivery of quality, patient-centered care, and diabetes self-management support. We concur with these suggestions, but would add that it is of interest to know exactly what skills the patients are performing to help control their conditions.

RE Glasgow et al. Where is the patient in diabetes performance measures? The case for including patient-centered and self-management measures. Diabetes Care, 2008;31:1046-1050.