Using collaborative learning to improve diabetes care and outcomes: the VIDA project.
The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology.


METHODS
Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure.


RESULTS
The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes.


CONCLUSIONS
The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
Barceló
Alberto
A
Pan American Health Organization, Washington, DC 20037-2895, USA. barceloa@paho.org
Cafiero
Elizabeth
E
de Boer
Melanie
M
Mesa
Alejandro Escobar
AE
Lopez
Marcelina García
MG
Jiménez
Rosa Aurora
RA
Esqueda
Agustín Lara
AL
Martinez
José Antonio
JA
Holguin
Esperanza Medina
EM
Meiners
Micheline
M
Bonfil
Gerson Moreno
GM
Ramirez
Saturnino Navarro
SN
Flores
Enrique Pérez
EP
Robles
Sylvia
S
D000328:Adult; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D019090:Case Management / Q000458:organization & administration; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human