title: Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
abstract: BACKGROUND
  The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care.
  
  
  METHODS
  This observational study took place in the period 2006-2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.
  
  
  RESULTS
  By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion.
  
  
  CONCLUSIONS
  According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.
authors.affiliation: Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium.
authors.forename: Viviane F A
authors.initials: VF
authors.lastname: Van Casteren
authors.affiliation: Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium.
authors.forename: Nathalie H E
authors.initials: NH
authors.lastname: Bossuyt
authors.affiliation: Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium.
authors.forename: Sarah J S
authors.initials: SJ
authors.lastname: Moreels
authors.affiliation: Katholieke Universiteit Leuven - Academisch Centrum voor Huisartsgeneeskunde, Kapucijnevoer 33 Blok J Bus 7001, 3000 Leuven, Belgium ; UZ Leuven - MIR (Management Informatie Rapportering, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.affiliation: Vrije Universiteit Brussel, Demografie, Pleinlaan 2, 1050 Brussel, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanthomme
authors.affiliation: Universiteit Antwerpen, Academisch Centrum voor Huisartsgeneeskunde, Campus 3 Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Wens
authors.affiliation: Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle aux Champs 30, 1200 Brussels, Belgium.
authors.forename: Etienne W
authors.initials: EW
authors.lastname: De Clercq
keywords: Chronic disease management; Primary care; Quality of care; Type 2 diabetes mellitus