title: Organizational determinants of high-quality routine diabetes care.
abstract: OBJECTIVE
  Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care.
  
  
  METHODS
  Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score.
  
  
  METHODS
  Primary care practices in the Netherlands.
  
  
  METHODS
  11,751 patients with diabetes in 354 practices.
  
  
  METHODS
  Patients' recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels.
  
  
  RESULTS
  A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12-2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06-6.35), and number of hours' nurse education on cholesterol control (OR = 2.51, 95% CI 1.02-6.15).
  
  
  CONCLUSIONS
  In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare , Nijmegen , The Netherlands.
authors.forename: Arna L
authors.initials: AL
authors.lastname: van Doorn-Klomberg
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: René J
authors.initials: RJ
authors.lastname: Wolters
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.forename: Wim J C
authors.initials: WJ
authors.lastname: de Grauw
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004506:Education, Nursing; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D012044:Regression Analysis
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin
keywords: Chronic disease; diabetes mellitus; general practice; observational study; practice management; primary health care; quality improvement; the Netherlands