title: The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study.
abstract: OBJECTIVE
  We investigated whether a continuous quality improvement programme in primary care for people with type 2 diabetes led to better care and outcomes in hard to reach groups.
  
  
  METHODS
  GEDAPS was implemented in Catalonia, Spain between 1993 (n=2239) and 2002 (n=5819). Process (e.g., education), intermediate (e.g., HbA1c) and final (e.g. retinopathy) outcomes were compared between urban and rural areas, and between younger (≤74 years) and older (≥75 years) individuals as examples of harder to reach groups.
  
  
  RESULTS
  In 1993, people in urban areas had significantly better or similar outcomes to rural areas; by 2002, most outcomes improved in urban and rural areas. For all outcomes, the improvement in rural areas was similar to or better than urban areas. Similarly, for most outcomes, the younger and older group improved, with the older group experiencing similar or better improvements than the younger group for all indicators, except coronary artery disease.
  
  
  CONCLUSIONS
  A quality improvement programme was associated with equivalent or better outcomes in hard to reach groups, regardless of whether they were specifically targeted. The ability to apply one programme to all populations could save time and money.
authors.affiliation: University of Leicester, Diabetes Research Centre, Leicester, UK. Electronic address: dhm6@le.ac.uk.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Bodicoat
authors.affiliation: University Public Health Center El Carmel, Barcelona, Spain; Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, redIAPP, Barcelona, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mundet
authors.affiliation: University of Leicester, Diabetes Research Centre, Leicester, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: University of Leicester, Diabetes Research Centre, Leicester, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, redIAPP, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Roura
authors.affiliation: Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, redIAPP, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Franch
authors.affiliation: Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, redIAPP, Barcelona, Spain; University Primary Health Care Center La Mina, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Mata-Cases
authors.affiliation: Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, redIAPP, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cos
authors.affiliation: Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Servicio de Endocrinologia, Hospital Universitari del Mar, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Franciso Cano
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health / Q000592:standards*; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014504:Urban Health
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Quality improvement; Quality of health care; Rural population; Type 2 diabetes mellitus