title: Trends over 8 years in quality of diabetes care: results of the AMD Annals continuous quality improvement initiative.
abstract: OBJECTIVE
  Quality of care monitoring is a key strategy for health policy. In Italy, the AMD Annals continuous monitoring and quality improvement initiative has been in place since 2006. Results after 8 years are now available.
  
  
  METHODS
  Quality of diabetes care indicators during the years 2004-2011 were extracted from electronic medical records of 300 diabetes clinics. From 200,000 to 500,000 patients with type 2 diabetes were analyzed per year. Six process indicators, eight intermediate outcome indicators, seven indicators of treatment intensity/appropriateness, and a quality of care summary score (Q score) were evaluated. Previous studies documented that the risk of developing a new cardiovascular event was 80 % higher in patients with a Q score <15 and 20 % higher in those with a score between 15 and 25, as compared to those with a score >25.
  
  
  RESULTS
  The proportion of patients with HbA1c ≤7 %, LDL cholesterol <100 mg/dl, and blood pressure ≥140/90 mmHg increased by 4.8, 21.9, and 10.0 %, respectively. Process and treatment intensity/appropriateness indicators consistently improved. The proportion of patients with a Q score <15 decreased from 13.5 to 6.5 %, while those with a Q score >25 increased from 22.9 to 38.5 %.
  
  
  CONCLUSIONS
  AMD Annals document the progress in quality of diabetes care. Longitudinal improvements in Q score can translate into less cardiovascular events, with evident clinical and economic implications. AMD Annals represent a physician-led effort not requiring allocation of extra-economic resources, which is easy to implement and deeply rooted in routine clinical practice. They are a potential case model for other healthcare systems.
authors.affiliation: AMD - Associazione Medici Diabetologi, Rome, Italy, mrossi@negrisud.it.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Rossi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Candido
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.forename: Antonino
authors.initials: A
authors.lastname: Cimino
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolo
authors.forename: Carlo
authors.initials: C
authors.lastname: Giorda
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Marina
authors.initials: M
authors.lastname: Maggini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Illidio
authors.initials: I
authors.lastname: Meloncelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Marco
authors.initials: M
authors.lastname: Scardapane
authors.forename: Giacomo
authors.initials: G
authors.lastname: Vespasiani
mesh_terms: D000368:Aged; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin