title: Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain.
abstract: OBJECTIVE
  To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia.
  
  
  METHODS
  Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals.
  
  
  RESULTS
  Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed.
  
  
  CONCLUSIONS
  Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.
authors.affiliation: Primary Care Center (PCC) La Mina, Sant Adrià de Besòs, Barcelona, Spain. manelmatacases@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Mata-Cases
authors.forename: P
authors.initials: P
authors.lastname: Roura-Olmeda
authors.forename: M
authors.initials: M
authors.lastname: Berengué-Iglesias
authors.forename: M
authors.initials: M
authors.lastname: Birulés-Pons
authors.forename: X
authors.initials: X
authors.lastname: Mundet-Tuduri
authors.forename: J
authors.initials: J
authors.lastname: Franch-Nadal
authors.forename: B
authors.initials: B
authors.lastname: Benito-Badorrey
authors.forename: J F
authors.initials: JF
authors.lastname: Cano-Pérez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D013030:Spain
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin