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Patient Safety and Quality

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A multipronged quality improvement strategy can markedly improve the quality of diabetes care and patient outcomes

Primary care practices that participate in a quality improvement project, which involves regular performance reports, occasional practice site visits by expert clinicians or pharmacists, and annual network meetings, can improve the care and outcomes of their patients with diabetes. A multipronged quality improvement project was conducted between January 1, 2004 and July 1, 2005 within 66 primary care practices in 33 States. It included 372 providers and 24,250 adults with diabetes.

Steven Ornstein, M.D., of the Medical University of South Carolina, and coinvestigators measured improvement on practice adherence to 13 measures of diabetes care and a summary measure, the Diabetes Summary Quality Index (Diabetes-SQUID). The average Diabetes-SQUID across all practices improved 7.8 percent from 50.6 percent on January 1, 2004, to 58.4 percent on July 1, 2005.

Significant improvements (generally between 5 and 10 percent) occurred for 12 of the 13 individual measures of diabetes care quality and patient outcomes:

  • Blood pressure and urine microalbumin monitoring.
  • Measurements of HDL cholesterol, LDL cholesterol, triglyceride, and glycosylated hemoglobin.
  • Prescription of antiplatelet therapy.
  • Control of blood pressure (less than 130/80), HDL-cholesterol (greater than 45 mg/dL), LDL-cholesterol (less than 100 mg/dL), triglycerides (less than 150 mg/dL), and glycosylated hemoglobin control (less than 7 percent).

Practice clinicians noted that the regular reports at site visits, network meetings, and other forms of communication helped them face the inadequacy of the care they delivered. These approaches also helped stimulate efforts to overcome clinical inertia to intensify diabetes medications and redesign office practices to involve nurses and other staff. Many practices also implemented disease management protocols that required more frequent visits by their patients.

The study was supported by the Agency for Healthcare Research and Quality (HS13716).

See "Improving diabetes care through a multicomponent quality improvement model in a practice-based research network," by Dr. Ornstein, Paul J. Nietert, Ph.D., Ruth G. Jenkins, Ph.D., and others, in the January 2007 American Journal of Medical Quality 22(1), pp. 34-41.

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