Background
To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape.
Methods
Based on document reviews, iterative working group discussions and expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets.
Results
To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level.
Conclusion
In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.
Objective. To use a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management.
Methods. Using cross-sectional data from the 2018 Belgian Health Interview Survey and Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression was used to identify risk factors for being unlinked to hypertension care, untreated and not followed up appropriately.
Results. The prevalence of hypertension based on self-reported and measured high blood pressure (BP) was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% was diagnosed. Furthermore, 53.4% of the hypertensive population was linked to care, 49.8% was in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Males, those of younger age, without comorbidity, and smokers, were more likely to be unlinked to care. Younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, females, those of younger age, and without comorbidity were more likely to receive no adequate follow-up.
Conclusion. Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are needed to improve the accurate and timely diagnosis of hypertension.
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