Randomized Trial of Quality Improvement Intervention to Improve Diabetes Care in Primary Care Settings

Abstract

OBJECTIVE -To assess the impact of a quality improvement (QI) intervention on the quality of diabetes care at primary care clinics.RESEARCH DESIGN AND METHODS -Twelve primary care medical practices were matched by size and location and randomized to intervention or control conditions. Intervention clinic staff were trained in a seven-step QI change process to improve diabetes care. Surveys and medical record reviews of 754 patients, surveys of 329 clinic staff, interviews with clinic leaders, and analysis of training session videotapes evaluated compliance with and impact of the intervention. Mixed-model nested analyses compared differences in the quality of diabetes care before and after intervention.RESULTS -All intervention clinics completed at least six steps of the seven-step QI change process in an 18-month period and, compared with control clinics, had broader staff participation in QI activities (P ϭ 0.04), used patient registries more often (P ϭ 0.03), and had better test rates for HbA 1c (A1C), LDL, and blood pressure (P ϭ 0.02). Other processes of diabetes care were unchanged. The intervention did not improve A1C (P ϭ 0.54), LDL (P ϭ 0.46), or blood pressure (P ϭ 0.69) levels or a composite of these outcomes (P ϭ 0.35).CONCLUSIONS -This QI change process was successfully implemented but failed to improve A1C, LDL, or blood pressure levels. Data suggest that to be successful, such a QI change process should direct more attention to specific clinical actions, such as drug intensification and patient activation.

Diabetes care among veteran women with disability

“…However, subgroup differences by age in testing and by race/ethnicity in HbA 1c testing and outcomes among disabled women suggest that subgroup-specific interventions may be needed to improve diabetes care. This is also consistent with a larger body of literature suggesting the lack of efficacy of global quality improvement programs for diabetes and hypertension (Grant et al, 2004;Murray et al, 2004;O'Connor et al, 2005).…”

Improving Diabetes Care in Practice

“…M a n y d i a b e t e s intervention studies are limited by inadequate sample size, nonrandomized patients and clinics, lack of control subjects, or limited scope of implementation within a single medical group or health system (11,13,14). Although some trials of quality improvement strategies have demonstrated small improvements in the process of care delivery, demonstrating improvement in control of A1C, LDL, and systolic blood pressure (SBP) has been more challenging (15)(16)(17)(18). The paucity of effective interventions improving diabetes care in primary care settings led us to design a "practical clinical trial" to test whether implementation of an organizational intervention could improve both diabetes care processes and clinical outcomes in primary care (19).…”

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

“…The Chronic Care Model highlights the importance of a population-based approach; involving community, patients and providers; and information technology [4][5][6] . Various combinations of population management, practice support, and patient outreach have been used for diabetes care in a variety of settings with mixed results [7][8][9][10][11][12][13][14][15][16] . Many practice interventions for diabetes have been carried out in academic and urban centers.…”