The Medical Society of Delaware's Uniform Clinical Guidelines for diabetes: did they have a positive impact on quality of diabetes care?
BACKGROUND
In 2001, the Diabetes Physician Committee of the Medical Society of Delaware developed Uniform Clinical Guidelines (UCGs) for diabetes mellitus. These guidelines were intended to provide a standard for the diabetes quality indicators that could be used by all providers and all major insurers in Delaware. The guidelines were sent to Delaware physicians in December 2001. This study examines whether implementation of the diabetes UCG had a positive impact on the quality of diabetes care in primary care offices.


METHODS
A chart review was conducted for 258 diabetic patients of 28 primary care physicians in all three counties in Delaware. Quality of care was compared from the year prior to guideline implementation (2001) to the year after implementation (2002). Quality was determined by process measures, including receipt of recommended monitoring tests (glycosylated hemoglobin, blood pressure, lipids, microalbumin, foot exams, eye exams) and immunizations (influenza and pneumococcal), as well as by outcome measures, including adequate glycemic control, blood pressure control, and lipid control.


RESULTS
There was no significant change in most quality indicators from the year before to the year after implementation of the UCG. The only improvements seen were in influenza immunizations and, to some extent, lipid and blood pressure control. However, none of these reached optimal levels, and for some process measures (microalbumin testing and eye exams) there was a decrease in adherence to guidelines. In a second analysis, physicians who used diabetes flow sheets had better quality of care for most measures, although these differences were relatively small and not consistent across all measures.


CONCLUSIONS
The Medical Society of Delaware's Uniform Clinical Guidelines are intended to standardize care for diabetes and other conditions. While the guidelines may help to reduce unnecessary duplication and confusion caused by multiple guidelines, this study showed that they have not yet resulted in substantial improvements in quality of care for diabetes. Since the study does suggest that using flow sheets is associated with somewhat better care, it could be that quality will improve as more physicians incorporate these tools into their practices.
Gill
James M
JM
Department of Family and Community Medicine at Christiana Care Health Services in Wilmington, Delaware, USA.
DiPrinzio
Marie J
MJ
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003691:Delaware; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies