Outcomes of audit-enhanced monitoring of patients with type 2 diabetes.
OBJECTIVE
To assess the outcome of diabetes care in a practice-based research network after the introduction of an audit-enhanced monitoring system (AEMS).


METHODS
An AEMS was introduced into family practices participating in the academic research network of Nijmegen University, Nijmegen, the Netherlands. One and 7 years later, a cross-sectional analysis was performed on the outcome of care in all type 2 diabetes patients under treatment by their family physicians.


METHODS
Approximately 42,000 patients in 1993 and approximately 46,000 patients in 1999 at 10 family practices participating in the university's academic research network.


METHODS
Targets of care were HbA1c < 8.5% and blood pressure < 150/85 mm Hg. Targets for lipids depended on age, cardiovascular morbidity, and smoking status.


RESULTS
In 1993, 540 type 2 diabetes patients were included; in 1999, 851 such patients were included, representing a prevalence of 1.3% and 2.0%, respectively. Glycemic control improved statistically significantly by the percentage of patients with HbA1c < 8.5% (87% vs 59%, P =.0001) and the mean HbA1c (7.1% vs 8.2%, P =.0001) from the first to the second cohort. Mean blood pressure and the percentage of patients above the target blood pressure did not change. The mean cholesterol (207 mg/dL vs 238 mg/dL [5.4 mmol/L vs 6.2 mmol/L], P =.0001) and the percentage of patients who met their target lipid levels (72% vs 52%, P =.001) also improved between 1993 and 1999. In addition, an increased percentage of patients attended an annual review in the past year (73% vs 84%).


CONCLUSIONS
Outcomes of diabetes care in a family practice research setting using an AEMS were comparable with those reported under randomized controlled trial conditions.
de Grauw
Wim J C
WJ
Dept of Family Medicine, Code HSV 229, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. w.degrauw@hsv.kun.nl.
van Gerwen
Willem H E M
WH
van de Lisdonk
Eloy H
EH
van den Hoogen
Henk J M
HJ
van den Bosch
Wil J H M
WJ
van Weel
Chris
C
D000368:Aged; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005194:Family Practice; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008331:Management Information Systems; D008485:Medical Audit; D008991:Monitoring, Physiologic; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic