Continuing improvement in type 2 diabetes care through performance-based evaluations.
OBJECTIVE
The timely evidence-based care of type 2 diabetes mellitus (T2DM) is imperative for achieving and maintaining glycemic control, reducing complications, and changing the paradigm of this epidemic. Based largely on results from earlier performance improvement (PI) activities, we conducted a continuing medical education (CME)-certified PI activity to foster improved adherence to guideline recommendations and current evidence for the care of patients with T2DM.


METHODS
Participants engaged in a 3-stage process of self-assessment, goal setting, and reassessment.


RESULTS
A total of 64 clinicians completed the entire PI process, abstracting data from 1600 patient charts before and after a period of self-improvement. After the intervention, clinicians were more likely to assess patients for disease-related complications and provide counseling on proper nutrition, exercise, and smoking cessation. Patients with A1C, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) values above goal (defined as A1C ≥7, BP ≥130/80 mm Hg, and LDL-C >100 g/dL) were more likely to receive treatment modifications compared with baseline clinician performance. Significant changes observed in patient outcomes included improved mean A1C values (baseline 7.5% vs postintervention 7.3%; P = .027), decreased likelihood of BP at or above 130/80 mm Hg (baseline 37% vs postintervention 30%; P < .001), and decreased likelihood of LDL-C above 100 g/dL (baseline 33% vs postintervention, 27%; P < .001).


CONCLUSIONS
Significant changes in clinician performance of key quality measures were reported in patients with T2DM after a PI CME activity improved adherence to evidence-based recommendations of care.
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Howard B A
HB
Baum
Enrico
E
Cagliero
Carolyn A
CA
Berry
William A
WA
Mencia
Stephanie A
SA
Stowell
Sara C
SC
Miller
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D055815:Young Adult
diabetes; patient health; performance improvement