title: Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.
abstract: OBJECTIVE
  To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support.
  
  
  METHODS
  This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again.
  
  
  RESULTS
  Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0.0001). The same applied to all six domains. The feedback and benchmark improved the total quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001).
  
  
  CONCLUSIONS
  Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands m.j.e.campmans-kuijpers@umcutrecht.nl.
authors.forename: Marjo J
authors.initials: MJ
authors.lastname: Campmans-Kuijpers
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Lidwien C
authors.initials: LC
authors.lastname: Lemmens
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D000554:Ambulatory Care Facilities / Q000592:standards; D065187:Controlled Before-After Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005246:Feedback; D005500:Follow-Up Studies; D006801:Humans; D009426:Netherlands; D010348:Patient Care Team; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D017749:Total Quality Management