title: Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.
abstract: BACKGROUND
  In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics.
  
  
  RESULTS
  Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%).Mean scores on the six domains for care groups and outpatient clinics respectively were: 'organisation of care' 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); 'multidisciplinary teamwork' 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); 'patient centeredness' 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); 'performance management' 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); 'quality improvement policy' 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and 'management strategies' 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on 'care program' (83.3%) and 'measured outcomes' (98.3%) and lowest on 'patient safety' (15.1%) and 'patient involvement' (17.7%). Outpatient clinics scored high on the presence of a 'diabetic foot team' (81.6%) and the support in 'self-management' (81.0%) and low on 'patient involvement' (26.8%) and 'inspection of medical file' (28.0%).
  
  
  CONCLUSIONS
  This nationwide assessment reveals that the level of quality management in diabetes care varies between several subdomains in both diabetes care groups and outpatient clinics.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands. m.j.e.campmans-kuijpers@umcutrecht.nl.
authors.forename: Marjo J E
authors.initials: MJ
authors.lastname: Campmans-Kuijpers
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Lidwien C
authors.initials: LC
authors.lastname: Lemmens
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006126:Group Processes; D006801:Humans; D009426:Netherlands; D011787:Quality of Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
references.citation: BMC Fam Pract. 2008 Jun 15;9:35
references.pmid: 18554418
references.citation: Med Care Res Rev. 2011 Jun;68(3):263-89
references.pmid: 21536606
references.citation: N Engl J Med. 2010 Oct 7;363(15):1389-91
references.pmid: 20925539
references.citation: Lancet. 2005 Nov 12;366(9498):1678-9
references.pmid: 16291048
references.citation: Int J Qual Health Care. 1999 Apr;11(2):119-30
references.pmid: 10442842
references.citation: N Engl J Med. 2009 Aug 6;361(6):551-3
references.pmid: 19657119
references.citation: N Engl J Med. 2011 Mar 17;364(11):990-1
references.pmid: 21410368
references.citation: Lancet. 2012 Jun 16;379(9833):2252-61
references.pmid: 22683130
references.citation: BMC Health Serv Res. 2013 Apr 05;13:129
references.pmid: 23561032
references.citation: Lancet. 2012 Jan 14;379(9811):189-91
references.pmid: 21920598
references.citation: Int J Qual Health Care. 2003 Jun;15(3):223-34
references.pmid: 12803350
references.citation: Int J Qual Health Care. 2002 Apr;14(2):91-101
references.pmid: 11954688
references.citation: BMJ. 2004 Jan 17;328(7432):159-61
references.pmid: 14726350
references.citation: Psychol Bull. 1968 Oct;70(4):213-20
references.pmid: 19673146
references.citation: N Engl J Med. 2011 Jul 28;365(4):e6
references.pmid: 21751898