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Quality improvement measures mean better care for patients with diabetes
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PHILADELPHIA — Implementing interventions to improve the quality of diabetes care, including strategies involving both patients and health care professionals, is an important way to enhance diabetes management, researchers said at the American Diabetes Association’s 72nd Scientific Sessions.
“Despite high quality evidence on treatment and prevention for patients with diabetes, they still are not getting the most optimal care, and this is known as the ‘know-do gap.’ Quality improvement strategies have been proposed to fill this gap,” Andrea C. Tricco, PhD, of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, said during a presentation. “We’re trying to get the best evidence into the hands of people who can really make a difference.”
Specific effects
To evaluate the effects of quality improvement strategies on specific outcomes, such as HbA1c, vascular risk management, microvascular complication monitoring and smoking cessation, Tricco and colleagues conducted a meta-analysis of clinical trials. They included 48 cluster randomized controlled trials and 94 patient randomized controlled trials, involving 84,865 and 38,664 patients, respectively.
Results revealed mean reductions of 0.37% (95% CI, 0.28-0.45) in HbA1c in 120 trials; 0.1 mmol/L (95% CI, 0.05-0.14) in LDL in 47 trials; 3.13 mm Hg (95% CI, 2.19-4.06) in systolic blood pressure in 65 trials; and 1.55 mm Hg (95% CI, 0.95-2.15) in diastolic BP in 61 trials, as compared with usual care. Baseline concentrations of greater than 8% for HbA1c; 2.59 mmol/L for LDL; 80 mm Hg for diastolic BP; and 140 mm Hg for systolic BP were associated with greater improvements in outcomes. Researchers also found that overall, the effectiveness of quality improvement strategies correlated with HbA1c control at baseline.
Additionally, Tricco said that patients in the quality improvement groups were more likely than those in the usual care groups to receive aspirin (RR=1.33; 95% CI, 1.21-2.45; 11 trials); antihypertensive drugs (RR=1.17; 95% CI, 1.01-1.37; 10 trials); and screening for retinopathy (RR=1.22; 95%, CI 1.13-1.32; 23 trials), renal function (RR=1.28; 95% CI, 1.13-1.44; 14 trials) and foot abnormalities (RR=1.27; 95% CI, 1.16-1.39).
Quality improvement did not appear to increase statin use (RR=1.12; 95% CI, 0.99-1.28; 10 trials), hypertension control, (RR=1.01; 95% CI, 0.96-1.07; 18 trials) and smoking cessation (RR=1.13; 95% CI, 0.99-1.29; 13 trials).
“Quality improvement strategies significantly improve intermediate disease outcomes. Although some of these outcomes were small, the effects are important on a population level,” Tricco said.
Implications
In an accompanying editorial, Martha M. Funnell, RS, RN, CDE, and Gretchen A. Piatt, PhD, MPH, said changing health care models may help further enhance implementation of these strategies.
“Redesigning care to use the skills of all members of the health care team might provide both the impetus and the ability for patients and practices to move beyond glycemic control to create a comprehensive, patient-centered and effective model of diabetes care,” they wrote. – by Melissa Foster
For more information:
- Funnell MM. Lancet. 2012;doi:1016/S0140-6736(12)60637-0.
- Tricco AC. Lancet. 2012;doi:10.1016/s0140-3763(12)60480-2.
- Tricco AC. Joint ADA/The Lancet Symposium. Presented at: the American Diabetes Association’s 72nd Scientific Sessions; June 8-12, 2012; Philadelphia.
Disclosures:
- Drs. Funnell, Piatt and Tricco report no relevant financial disclosures.