Four‐year impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics: the AMD‐Annals initiative

Abstract

Aims We evaluated the impact of a continuous quality improvement effort implemented by a network of Italian diabetes clinics operating in the national healthcare system.Methods This was a controlled before-and-after study involving 95 centres, of which 67 joined the initiative since 2004 (group A) and 18 were first involved in 2007 (group B, control). All centres used electronic medical record systems. Information on quality indicators was extracted for the period 2004-2007. Data were centrally analysed anonymously and results were published annually. Each centre's performance was ranked against the 'best performers'. We compared quality indicators between the two groups of centres over 4 years.Results Over 100 000 Type 2 diabetes mellitus patients were evaluated annually. The proportion of patients with glycated haemoglobin levels < 7% increased by 6% in group A (2007-2004 difference) and by 1.3% in group B. The proportion of patients with low-density lipoprotein-cholesterol < 100 mg ⁄ dl improved by over 10% in both groups. The rate of patients with blood pressure values £ 130 ⁄ 85 mmHg increased in group A (+6.4%), but not in group B (-1.4%). The use of insulin increased in group A only (+5.2%), while the use of statins increased by over 20% in both groups.Conclusions A physician-led quality improvement effort, based on the systematic evaluation of routine data, is effective in improving the performance of a large number of diabetes clinics. The small percentage increase in the number of patients at target, if applied to large numbers of patients, would translate into a significant impact on public health.

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

“…As already reported [17][18][19], in Italy, diabetes care is mostly provided by a public network of about 700 diabetes clinics in which a team of specialists provides diagnostic confirmation, prevention and treatment for diabetes and its complications through close patients follow-up and regular checkups [17][18][19]. In the present study we selected a large cohort of patients with T2D followed up at 90 diabetes centers in Italy among those participating in the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative.…”

“…Participating centers adopted the same software systems for everyday management of outpatients, whereas a specially developed software package allowed us to extract the information we intended to analyze from all the clinical databases (AMD Data File). Moreover, data from all participating centers were collected and centrally analyzed anonymously [17][18][19]. All patients gave their informed consent and internal approval was obtained by the AMD annals Scientific Committee.…”

Serum Uric Acid and Risk of CKD in Type 2 Diabetes

“…In Italy, diabetes care is mainly provided by a public network of about 700 diabetes clinics, where a team of specialists provide diagnostic confirmation and prevention and treatment of diabetes and its complications through close patient follow-up and regular check-ups (22,23).…”

“…Participating centers adopted the same software systems for the everyday management of outpatients, while a specially developed software package allowed us to extract the information we intended to analyze from all the clinical databases (AMD data file). Moreover, data from all participating centers were collected and centrally analyzed anonymously (22). The results were internally approved by the AMD Annals scientific committee.…”

A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?

“…13,[35][36][37] Inertia has been mostly thought to depend on (i) low GP propensity to changes, (i) poor care management DCU organization and eventually (iii) temporary unavailability of a specific drug 38,39 but our study showed that something eventually prevented even diabetologists from following best practice recommendations since the first visit.…”