title: Quality of diabetes care predicts the development of cardiovascular events: results of the AMD-QUASAR study.
abstract: OBJECTIVE
  The QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian Diabetes Patients) study aimed to assess whether a quality-of-care summary score predicted the development of cardiovascular (CV) events in patients with type 2 diabetes.
  
  
  METHODS
  In 67 diabetes clinics, data on randomly selected patients were extracted from electronic medical records. The score was calculated using process and outcome indicators based on monitoring, targets, and treatment of A1C, blood pressure, LDL cholesterol, and microalbuminuria. The score ranged from 0 to 40.
  
  
  RESULTS
  Overall, 5,181 patients were analyzed; 477 (9.2%) patients developed a CV event after a median follow-up of 28 months. The incidence rate (per 1,000 person-years) of CV events was 62.4 in patients with a score of <15, 41.0 in those with a score between 20 and 25 and 36.7 in those with a score of >25. Multilevel analysis, adjusted for clustering and case-mix, showed that the risk to develop a new CV event was 84% higher in patients with a score of <15 (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] 1.29-2.62) and 17% higher in those with a score between 15 and 25 (IRR = 1.17; 95% CI 0.93-1.49) compared with those with a score of >25. Mean quality score varied across centers from 16.5 ± 7.5 to 29.1 ± 6.3. When the score was tested as the dependent variable, it emerged that 18% of the variance in the score could be attributed to setting characteristics.
  
  
  CONCLUSIONS
  Our study documented a close relationship between quality of diabetes care and long-term outcomes. A simple score can be used to monitor quality of care and compare the performance of different centers/physicians.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy. mrossi@negrisud.it
authors.forename: Maria C E
authors.initials: MC
authors.lastname: Rossi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Marco
authors.initials: M
authors.lastname: Comaschi
authors.forename: Carlo
authors.initials: C
authors.lastname: Coscelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Cucinotta
authors.forename: Patrizia
authors.initials: P
authors.lastname: Di Blasi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bader
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Umberto
authors.initials: U
authors.lastname: Valentini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011787:Quality of Health Care / Q000706:statistics & numerical data*