Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice.
OBJECTIVE
To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes.


METHODS
A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA(1c) and blood lipid levels. Main patient outcomes were blood pressure and HbA(1c) and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices.


RESULTS
Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01-5.82) for the measurement of urine albumin to 12.08 (4.70-31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome.


CONCLUSIONS
The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.
Renders
C M
CM
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam. CM.Renders.emgo@med.vu.nl
Valk
G D
GD
Franse
L V
LV
Schellevis
F G
FG
van Eijk
J T
JT
van der Wal
G
G
D000368:Aged; D000419:Albuminuria; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010821:Physicians, Family; D011785:Quality Assurance, Health Care; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D014280:Triglycerides