Organization of a quality-assurance project in all Belgian multidisciplinary diabetes centres treating insulin-treated diabetes patients: 5 years' experience.
Adolescent; Adult; Aged; Belgium; Diabetes Mellitus, Type 1/complications/drug therapy; Diabetes Mellitus, Type 2/complications/drug therapy; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Quality Assurance, Health Care/methods
Abstract :
[en] AIMS: To describe the IQED, a quality-assurance system started in 2001 in Belgian hospital-based multidisciplinary diabetes centres, and its effects on the quality of care. METHODS: The study was conducted through four data collections (in 2001, 2002, 2004 and 2006). Approximately 120 diabetes centres provided data on a systematic random sample of 10% of their adult diabetic patients on at least two daily insulin injections. Data on patient characteristics, glycaemic control, cardiovascular risk, diabetes complications, follow-up procedures and treatment were obtained. Local quality promotion was encouraged by returning comprehensive feedback (benchmarks) and during information meetings. RESULTS: Nearly all diabetes centres (98-100%) participated. The pooled sample consisted of 9194 (32%) Type 1 and 19 828 (68%) Type 2 diabetes patients, with mean diabetes duration of 17 years and 14 years, prevalence of microvascular complications of 23% and 38% and prevalence of macrovascular complications of 9% and 26%, respectively. At the start, the quality of care was good in terms of risk-factor testing rates and moderate in terms of patients meeting goals for risk-factor management. At least 50% of the centres initiated quality-promoting initiatives. After 5 years, significant improvements were seen in risk-factor testing rates, apart from renal screening. Improvements in intermediate outcomes were less obvious, apart from an increase in patients reaching the targets for blood pressure and LDL cholesterol. CONCLUSIONS: It is feasible to implement a continuous quality-improvement project on a nationwide scale, with improvements particularly in process indicators.
Disciplines :
Public health, health care sciences & services Endocrinology, metabolism & nutrition
Author, co-author :
Debacker, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > Salle de médecine interne infectiologie -1C
Nobels, F.
Vandenberghe, H.
Van Crombrugge, P.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Van Casteren, V.
Language :
English
Title :
Organization of a quality-assurance project in all Belgian multidisciplinary diabetes centres treating insulin-treated diabetes patients: 5 years' experience.
Publication date :
2008
Journal title :
Diabetic Medicine: A Journal of the British Diabetic Association
American Diabetes Association. Standards of medical care in diabetes - 2006. Diabetes Care 2006 29 (Suppl. 1 4 42.
McFarlane SI, Jacober SJ, Winer N, Kaur J, Castro JP, Wui MA et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. Diabetes Care 2002 25 : 718 723.
Narayan KM, Benjamin E, Gregg EW, Norris SL, Engelgau MM. Diabetes translation research: where are we and where do we want to be? Ann Intern Med 2004 140 : 958 963.
Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 2002 136 : 565 574.
Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ et al. Effects of quality improvement strategies for Type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006 296 : 427 440.
Tabak AG, Tamas G, Zgibor J, Wilson R, Becker D, Kerenyi Z et al. Targets and reality: a comparison of health care indicators in the US (Pittsburgh Epidemiology of Diabetes Complications Study) and Hungary (DiabCare Hungary). Diabetes Care 2000 23 : 1284 1289.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972 18 : 499 502.
Diabetes Physician Recognition Program. Internet Communication. http://www.ncqa.org/dprp/DPRPbrochfinal.pdf. Last accessed 12 March 2007.
Suwattee P, Lynch JC, Pendergrass ML. Quality of care for diabetic patients in a large urban public hospital. Diabetes Care 2003 26 : 563 568.
Bayingana K, Demarest S, Gisle L, Hesse E, Miermans PJ, Tafforeau J et al. Gezondheidstoestand: chronische aandoeningen. In : Scientific Institute of Public Health ed. Gezondheidsenquête door middel van Interview (HIS), België, 2004. Brussels : Scientific Institute of Public Health, 2006 47 186.
Puddu M, Van Casteren V. Diabetesregistratie huisartsen peilpraktijken. Diabetes (Type 1 en 2) in 2000: regionale verschillen in incidentie, prevalentie en behandeling. Resultaten van de huisartsenpeilpraktijken. In : Ministerie van de Vlaamse Gemeenschap ed. Gezondheidindicatoren. Brussels : Claes-Printing, 2002 : 143 151.
Grant RW, Buse JB, Meigs JB. Quality of diabetes care in US academic medical centers: low rates of medical regimen change. Diabetes Care 2005 28 : 337 442.
Edwards R, Burns JA, McElduff P, Young RJ, New JP. Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK. Diabetologia 2003 46 : 750 759.
Mangione CM, Gerzoff RB, Williamson DF, Steers WN, Kerr EA, Brown AF et al. The association between quality of care and the intensity of diabetes disease management programs. Ann Intern Med 2006 145 : 107 116.
Valk GD, Renders CM, Kriegsman DM, Newton KM, Twisk JW, van Eijk JT et al. Quality of care for patients with Type 2 diabetes mellitus in the Netherlands and the United States: a comparison of two quality improvement programs. Health Serv Res 2004 39 : 709 725.
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with Type 2 diabetes. N Engl J Med 2003 348 : 383 393.
New JP, Hollis S, Campbell F, McDowell D, Burns E, Dornan TL et al. Measuring clinical performance and outcomes from diabetes information systems: an observational study. Diabetologia 2000 43 : 836 843.
Whitford DL, Roberts SH, Griffin S. Sustainability and effectiveness of comprehensive diabetes care to a district population. Diabet Med 2004 21 : 1221 1228.
Beaton SJ, Nag SS, Gunter MJ, Gleeson JM, Sajjan SS, Alexander CM. Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting. Diabetes Care 2004 27 : 694 698.
The Writing Team for the Diabetes Control Complications Trial/Epidemiology of Diabetes Interventions Complications Research Group. Effect of intensive therapy on the microvascular complications of Type 1 diabetes mellitus. JAMA 2002 287 : 2563 2569.
Deichmann RE, Castello E, Horswell R, Friday KE. Improvements in diabetic care as measured by HbA1c after a physician education project. Diabetes Care 1999 22 : 1612 1616.
Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med 2003 348 : 2218 2227.
McClain MR, Wennberg DE, Sherwin RW, Steinmann WC, Rice JC. Trends in the diabetes quality improvement project measures in Maine from 1994 to 1999. Diabetes Care 2003 26 : 597 601.
Morris AD, Boyle DI, MacAlpine R, Emslie-Smith A, Jung RT, Newton RW et al. The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration. BMJ 1997 315 : 524 528.
Van Casteren V, De Clercq E, Lafontaine MF, Degroote K, Jonckheer P, Burggraeve P. Quality of care assessment using data from the Belgian general practitioners' Electronic Patient Record. A pilot study for hypertensive patients with high cardiovascular risk, February-April 2005. Eur J Public Health 2006 16 (Suppl. 1 1.
Guthrie B, Emslie-Smith A, Morris A, Fahey T, Sullivan F. Quality measurement of care for people with Type 2 diabetes in Tayside, Scotland: implications for the new UK general practice contract. Br J Gen Pract 2003 53 : 709 713.
Ettner SL, Thompson TJ, Stevens MR, Mangione CM, Kim C, Neil SW et al. Are physician reimbursement strategies associated with processes of care and patient satisfaction for patients with diabetes in managed care? Health Serv Res 2006 41 : 1221 1241.
Fisher ES. Paying for performance - risks and recommendations. N Engl J Med 2006 355 : 1845 1847.
Lindenauer PK, Remus D, Roman S, Rothberg MB, Benjamin EM, Ma A et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med 2007 356 : 486 496.
