Quality Improvement Initiatives

Issues in moving from diabetes guidelines to policy

  1. Rodney A. Hayward, MD123,
  2. Timothy P. Hofer, MD, MSc123,
  3. Eve A. Kerr, MD, MPH12 and
  4. Sarah L. Krein, PHD, RN12
  1. 1VA Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
  2. 2Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
  3. 3Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
  1. Address correspondence and reprint requests to Rodney A. Hayward, MD, Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, P.O. Box 130170, Mailstop 11H, Ann Arbor, MI 48113. E-mail: rod.hayward{at}med.va.gov

Abstract

OBJECTIVE—To outline the principles that direct the Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) dedicated to diabetes quality improvement (QUERI-DM).

RESEARCH DESIGN AND METHODS—We discuss the VA initiatives aimed at improving diabetes care for veterans as well as general issues that should be considered in quality improvement initiatives. We specifically describe some of the epidemiological, statistical, and organizational issues that have guided our quality improvement (QI) programs.

RESULTS—The five principles that have guided the QUERI-DM process are: 1) treating clinical guidelines and goals distinct from quality standards and quality improvement priorities; 2) targeting high-risk patients and high-impact quality issues; 3) profiling processes over outcomes; 4) targeting processes that will improve patient outcomes; and 5) paying attention to the loci of practice variation.

CONCLUSIONS—The authors recommend that all five principles be considered when moving from practice guidelines to performance measures and QI initiatives. Targeting high-priority problems and high-risk groups can greatly improve the effectiveness and efficiency of QI interventions.

Footnotes

  • Funding for this supplement was provided by The Seattle Epidemiologic Research and Information Center and the VA Cooperative Studies Program.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 25, 2003.
    • Received July 1, 2003.
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This Article

  1. doi: 10.2337/diacare.27.suppl_2.B54 Diabetes Care May 2004 vol. 27 no. suppl 2 b54-b60
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