Improving diabetes preventive care in a family practice residency program: a case study in continuous quality improvement.
OBJECTIVE
The paradigm of continuous quality improvement (CQI) holds promise for application in clinical settings. This paper highlights results of a CQI project developed and implemented in a residency-based, ambulatory family medicine center for management of non-insulin-dependent diabetes mellitus.


METHODS
We developed a CQI program that used several indicators of diabetes management as measures of quality care. These included dietary counseling, exercise counseling, foot care counseling, ophthalmology referral, and measurement of hemoglobin AIC and renal function.


RESULTS
Overall, compliance with recommendations for diabetes management increased from a baseline proportion of 40% to a level of 70% at the end of 1 year. During the second year, overall compliance was maintained at this level despite the inclusion of additional performance indicators.


CONCLUSIONS
The CQI process can improve physician performance in managing patients with diabetes.
Fox
C H
CH
Department of Family Medicine, State University of New York at Buffalo, USA. cfox@ubmedd.buffalo.edu
Mahoney
M C
MC
D002983:Clinical Competence; D003153:Community Health Services; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005194:Family Practice / Q000193:education*; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008485:Medical Audit; D010818:Practice Patterns, Physicians'; D011315:Preventive Medicine / Q000193:education*; D015397:Program Evaluation; D011897:Random Allocation; D012189:Retrospective Studies