Article type
Year
Abstract
Background: Diabetes mellitus has reached epidemic levels and quality of care gaps are persistent. Quality improvement (QI) strategies are commonly implemented at great cost, but the best approach to improve the provision of diabetes care remains uncertain.
Objectives: To evaluate the effects of QI strategies on the management of diabetes.
Methods: Systematic review of published and unpublished studies in MEDLINE (1966 to July 2010), Cochrane Effective Practice and Organisation of Care (EPOC) database (July 2010), and references of included trials. Randomized controlled trials (RCTs) examining 11 pre-defined QI strategies targeting healthcare professionals for managing adult outpatients with diabetes were included. RCTs lacking data (on glycemic control (HbA1c), blood pressure (BP), or write-out LDL cholesterol), RCTs focusing only on interventions at the patient level, and RCTs not written in English were excluded. Two reviewers independently extracted data and appraised risk of bias using the Cochrane EPOC tool.
Results: Data from 145 RCTs and 20 companion reports were included. Compared with usual care, the QI strategies statistically improved HbA1c (117 studies, mean difference [MD] -0.4% [95% confidence interval {CI} -0.5 to -0.3%]), LDL (45 studies, MD -4.1 mg/dL [-5.8 to -2.5 mg/dL]), systolic BP (66 studies, MD -3.7 mmHg [-4.6 to -2.6 mmHg]), and diastolic BP (61 studies, MD -1.6 mmHg [-2.4 to -0.7 mmHg]). After adjusting for sample size and other factors, QI strategies with the most significant improvement included case management, team changes, and patient education.
Conclusions: Some QI strategies were more successful than others in improving outcomes. Clinicians and policy-makers can use these results to tailor the choice of intervention according to the desired outcome, available resources, and local healthcare context.
Objectives: To evaluate the effects of QI strategies on the management of diabetes.
Methods: Systematic review of published and unpublished studies in MEDLINE (1966 to July 2010), Cochrane Effective Practice and Organisation of Care (EPOC) database (July 2010), and references of included trials. Randomized controlled trials (RCTs) examining 11 pre-defined QI strategies targeting healthcare professionals for managing adult outpatients with diabetes were included. RCTs lacking data (on glycemic control (HbA1c), blood pressure (BP), or write-out LDL cholesterol), RCTs focusing only on interventions at the patient level, and RCTs not written in English were excluded. Two reviewers independently extracted data and appraised risk of bias using the Cochrane EPOC tool.
Results: Data from 145 RCTs and 20 companion reports were included. Compared with usual care, the QI strategies statistically improved HbA1c (117 studies, mean difference [MD] -0.4% [95% confidence interval {CI} -0.5 to -0.3%]), LDL (45 studies, MD -4.1 mg/dL [-5.8 to -2.5 mg/dL]), systolic BP (66 studies, MD -3.7 mmHg [-4.6 to -2.6 mmHg]), and diastolic BP (61 studies, MD -1.6 mmHg [-2.4 to -0.7 mmHg]). After adjusting for sample size and other factors, QI strategies with the most significant improvement included case management, team changes, and patient education.
Conclusions: Some QI strategies were more successful than others in improving outcomes. Clinicians and policy-makers can use these results to tailor the choice of intervention according to the desired outcome, available resources, and local healthcare context.