Diabetes Management Quality Improvement
Diabetes Management Quality Improvement
Background: Diabetes is a devastating chronic disease. Although optimal diabetes control reduces chronic complications, actual provision of diabetes care frequently falls short of accepted guidelines. We wanted to determine whether locally developed diabetes care initiatives can result in improvements in the provision of diabetes care.
Methods: This study was a retrospective cohort analysis using Medicare claims and chart abstraction data to ascertain diabetes care indicator utilization rates at the Northeast Iowa Family Practice Clinic (NEIFPC), which serves as the training site for the Northeast Iowa Family Practice Residency Program. Diabetic patients receiving care at the NEIFPC during 1996, 1997, and 1998 were included. Diabetes care rates are compared with those of other Iowa practices.
Diabetes initiatives included chart audits, glycosylated hemoglobin (HbA1c) measurement reminder cards, educational symposia, an endocrinology outreach clinic, resident elective rotations, diabetes flow sheet utilization, pharmacist interface, and nursing foot-examination preparations. The primary outcome was the utilization rate of accepted diabetes care indicators.
Results: Diabetic patients at NEIFPC had greater utilization of diabetes care indicators than did patients of Iowa collaborators in 1997 and 1998. NEIFPC patients had HbA1c levels measured more frequently in 1997 and 1998 (84% and 88%, respectively) than did patients of Iowa collaborators (49% and 41%, respectively) (P < .001). The mean 1997 and 1998 HbA1c levels of 7.32% and 7.25%, respectively, are impressive compared with that of Iowa collaborators (8.83% and 8.36%) (P < .001) and other published data (8.5%-10%). The percentage of NEIFPC patients with good glycemic control (HbA1c < 8%) was 75%, compared with the reported 50% of all US patients.
Conclusions: Our findings suggest that multimodal diabetes care quality improvement initiatives, applied longitudinally, can result in significant improvements in the provision and documentation of diabetes care.
Diabetes is a devastating chronic disease that affects 15.7 million Americans, of whom only 10.3 million have this condition diagnosed. More than 70% of diabetic persons die of macrovascular disease associated with myocardial infarction and stroke. The Diabetes Control and Complications Trial has shown convincingly that improved glycemic control can substantially reduce the risk of microvascular complications in persons with type 1 diabetes. More recently, the United Kingdom Prospective Diabetes Study confirmed similar risk reduction in patients with type 2 diabetes. Even moderate reductions in hyperglycemia, hypertension, and dyslipidemia translate into markedly improved outcomes. The degree of glycemic exposure is best determined by measurement of glycosylated hemoglobin A (HbA1c), which reflects the average glucose level for the preceding 2 to 3 months.
Major treatment goals in the diabetic patient are to optimize blood glucose control, reduce weight, and normalize lipid abnormalities and blood pressure. The American Diabetes Association (ADA) clinical practice guidelines reflect these goals, including tight blood glucose control, with an HbA1c of less than 7.0%. Ensuring these diabetes care guidelines are incorporated into the daily practice of primary care providers requires substantial education and effort. Clearly there are shortcomings and variations in adherence to diabetes care recommendations in office-based primary care practice. The mean level of HbA1c for a population of patients and the percentage of patients cared for by a physician or a health care delivery system whose HbA1c reading is below a specific level have been suggested as diabetes quality-outcome indicators. Risk stratification, although imperfect, is necessary to make fair comparisons.
The Northeast Iowa Family Practice Clinic (NEIFPC) has used several quality initiative measures to increase provider compliance with national diabetes care guidelines. We report the cumulative success of these efforts in improving care of the NEIFPC diabetic population as compared with other Iowa physicians and with other published national data.
Background: Diabetes is a devastating chronic disease. Although optimal diabetes control reduces chronic complications, actual provision of diabetes care frequently falls short of accepted guidelines. We wanted to determine whether locally developed diabetes care initiatives can result in improvements in the provision of diabetes care.
Methods: This study was a retrospective cohort analysis using Medicare claims and chart abstraction data to ascertain diabetes care indicator utilization rates at the Northeast Iowa Family Practice Clinic (NEIFPC), which serves as the training site for the Northeast Iowa Family Practice Residency Program. Diabetic patients receiving care at the NEIFPC during 1996, 1997, and 1998 were included. Diabetes care rates are compared with those of other Iowa practices.
Diabetes initiatives included chart audits, glycosylated hemoglobin (HbA1c) measurement reminder cards, educational symposia, an endocrinology outreach clinic, resident elective rotations, diabetes flow sheet utilization, pharmacist interface, and nursing foot-examination preparations. The primary outcome was the utilization rate of accepted diabetes care indicators.
Results: Diabetic patients at NEIFPC had greater utilization of diabetes care indicators than did patients of Iowa collaborators in 1997 and 1998. NEIFPC patients had HbA1c levels measured more frequently in 1997 and 1998 (84% and 88%, respectively) than did patients of Iowa collaborators (49% and 41%, respectively) (P < .001). The mean 1997 and 1998 HbA1c levels of 7.32% and 7.25%, respectively, are impressive compared with that of Iowa collaborators (8.83% and 8.36%) (P < .001) and other published data (8.5%-10%). The percentage of NEIFPC patients with good glycemic control (HbA1c < 8%) was 75%, compared with the reported 50% of all US patients.
Conclusions: Our findings suggest that multimodal diabetes care quality improvement initiatives, applied longitudinally, can result in significant improvements in the provision and documentation of diabetes care.
Diabetes is a devastating chronic disease that affects 15.7 million Americans, of whom only 10.3 million have this condition diagnosed. More than 70% of diabetic persons die of macrovascular disease associated with myocardial infarction and stroke. The Diabetes Control and Complications Trial has shown convincingly that improved glycemic control can substantially reduce the risk of microvascular complications in persons with type 1 diabetes. More recently, the United Kingdom Prospective Diabetes Study confirmed similar risk reduction in patients with type 2 diabetes. Even moderate reductions in hyperglycemia, hypertension, and dyslipidemia translate into markedly improved outcomes. The degree of glycemic exposure is best determined by measurement of glycosylated hemoglobin A (HbA1c), which reflects the average glucose level for the preceding 2 to 3 months.
Major treatment goals in the diabetic patient are to optimize blood glucose control, reduce weight, and normalize lipid abnormalities and blood pressure. The American Diabetes Association (ADA) clinical practice guidelines reflect these goals, including tight blood glucose control, with an HbA1c of less than 7.0%. Ensuring these diabetes care guidelines are incorporated into the daily practice of primary care providers requires substantial education and effort. Clearly there are shortcomings and variations in adherence to diabetes care recommendations in office-based primary care practice. The mean level of HbA1c for a population of patients and the percentage of patients cared for by a physician or a health care delivery system whose HbA1c reading is below a specific level have been suggested as diabetes quality-outcome indicators. Risk stratification, although imperfect, is necessary to make fair comparisons.
The Northeast Iowa Family Practice Clinic (NEIFPC) has used several quality initiative measures to increase provider compliance with national diabetes care guidelines. We report the cumulative success of these efforts in improving care of the NEIFPC diabetic population as compared with other Iowa physicians and with other published national data.
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