OBJECTIVE: To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS: A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA(1c) and blood lipid levels. Main patient outcomes were blood pressure and HbA(1c) and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. RESULTS: Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01-5.82) for the measurement of urine albumin to 12.08 (4.70-31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome. CONCLUSIONS: The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.
OBJECTIVE: To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS: A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA(1c) and blood lipid levels. Main patient outcomes were blood pressure and HbA(1c) and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. RESULTS:Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01-5.82) for the measurement of urine albumin to 12.08 (4.70-31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome. CONCLUSIONS: The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.
Authors: Erwin P Klein Woolthuis; Wim J C de Grauw; Willem H E M van Gerwen; Henk J M van den Hoogen; Eloy H van de Lisdonk; Job F M Metsemakers; Chris van Weel Journal: Ann Fam Med Date: 2009 Sep-Oct Impact factor: 5.166
Authors: David P Stevens; Judith L Bowen; Julie K Johnson; Donna M Woods; Lloyd P Provost; Halsted R Holman; Constance S Sixta; Ed H Wagner Journal: J Gen Intern Med Date: 2010-09 Impact factor: 5.128
Authors: George Rust; Morna Gailor; Elvan Daniels; Barbara McMillan-Persaud; Harry Strothers; Robert Mayberry Journal: Int J Health Care Qual Assur Date: 2008
Authors: Gerlof D Valk; Carry M Renders; Didi M W Kriegsman; Katherine M Newton; Jos W R Twisk; Jacques Th M van Eijk; Gerrit van der Wal; Edward H Wagner Journal: Health Serv Res Date: 2004-08 Impact factor: 3.402