The Diabetes Quality Improvement Project

Moving science into health policy to gain an edge on the diabetes epidemic

  1. Barbara B. Fleming, MD, PHD1,
  2. Sheldon Greenfield, MD2,
  3. Michael M. Engelgau, MD, MS3,
  4. Leonard M. Pogach, MD, MBA4,
  5. Steven B. Clauser, PHD1,
  6. Marian A. Parrott, MD5 and
  7. For the DQIP Group
  1. 1Health Care Financing Administration, Baltimore, Maryland
  2. 2Primary Care Outcomes Research Institute, New England Medical Center Hospitals and Tufts University School of Medicine, Boston, Massachusetts
  3. 3Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  4. 4Medical Services, VA New Jersey Health Care System, East Orange, New Jersey
  5. 5American Diabetes Association, Alexandria, Virginia

    Background

    As the worldwide diabetes epidemic continues to unfold, some experts have asked whether the war against it is being lost (1,2,3). In the U.S., blindness, kidney failure, amputations, and cardiovascular disease resulting from diabetes not only markedly reduce quality and length of life but also cost nearly $100 billion annually (4,5,6,7). Fortunately, a vast body of research has clearly established that several effective treatments and practices may substantially reduce or prevent this burden (8,9,10,11,12,13,14,15,16,17,18,19). These interventions, if broadly implemented, can allow us to use our health efforts and resources more effectively and efficiently to minimize the diabetes burden. Judging from the scant data available, however, the level of care currently delivered to populations with diabetes often may not produce the possible health-related gains (20,21). To assess more completely the level of diabetes care delivered in the U.S., we need standardized uniform performance measures that can assess quality of care accurately and reliably. These measures will enhance uptake of research into practice and may ultimately improve diabetes care and clinical outcomes. In the early to mid-1990s, many organizations developed performance measures for diabetes care, but the result was that providers were often required to collect and report many different, sometimes conflicting, measures, depending on their care delivery system. It was recognized that a national consensus on measures could enhance this process and provide a method for assessing care within and across health care settings while providing a meaningful mechanism for quality improvement (QI). In this review, we describe the Diabetes Quality Improvement Project (DQIP), which has developed and implemented a comprehensive set of national measures for evaluation …

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