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Long-Term Effectiveness of a Quality Improvement Program for Patients With Type 2 Diabetes in General Practice

¹ Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam
² Department of General Practice, Vrije Universiteit, Amsterdam
³ Netherlands Institute for Health Services Research (Nivel), Utrecht
⁴ Department of Medical Sociology, University of Maastricht, Maastricht
⁵ Department of Social Medicine, Vrije Universiteit, Amsterdam, the Netherlands

OBJECTIVE—To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes.

RESEARCH DESIGN AND METHODS—A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA_1c and blood lipid levels. Main patient outcomes were blood pressure and HbA_1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices.

RESULTS—Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01–5.82) for the measurement of urine albumin to 12.08 (4.70–31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome.

CONCLUSIONS—The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.

Abbreviations: BP, blood pressure • GP, general practitioner • IG, intervention group • OR, odds ratio • RG, reference group • TC, total cholesterol

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