A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2).
OBJECTIVE
To evaluate the effect of multifaceted interventions using the Achievable Benchmark of Care (ABC) method for improving the technical quality of diabetes care in primary care settings.


METHODS
We conducted a 1-year cluster randomized controlled trial in 22 regions divided into an intervention group (IG) or control group (CG). Physicians in the IG received a monthly report of their care quality, with the top 10% quality of diabetes care scores for all physicians being the achievable benchmark. The change in quality-of-care scores between the IG and CG during follow-up was analysed using a generalized linear model considering clustering.


RESULTS
A total of 2199 patients were included. Their mean (sd) age was 56.5 ± 5.9 years and the mean (sd) HbA1c level was 56.4 ± 13.3 mmol/mol (7.4 ± 1.2%). The quality-of-care score in the CG changed from 50.2%-point at baseline to 51%-point at 12 months, whereas the IG score changed from 49.9%-point to 69.6%-point, with statistically significant differences between the two groups during follow-up [the effect of intervention was 19.0%-point (95% confidence interval 16.7%- to 21.3%-point; P < 0.001)].


CONCLUSIONS
Multifaceted intervention, measuring quality-of-care indicators and providing feedback regarding the quality of diabetes care to physicians with ABC, was effective for improving the technical quality of care in patients with Type 2 diabetes in primary care settings. (


BACKGROUND
umin.ac.jp/ctr as UMIN000002186).
Department of Endocrinology, Tenri Hospital, Nara, Japan.
Y
Y
Hayashino
Japan Community Health Care Organization Takaoka Fushiki Hospital, Takaoka, Japan.
H
H
Suzuki
Kawai Clinic, Tsukuba, Japan.
K
K
Yamazaki
Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
A
A
Goto
Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
K
K
Izumi
Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan.
M
M
Noda
D019985:Benchmarking; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D003927:Diet, Diabetic; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D000068156:Formative Feedback; D006442:Glycated Hemoglobin / Q000032:analysis; D000070497:Healthy Lifestyle; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human