Healthcare quality improvement programme improves monitoring of people with diabetes

Question

Does a healthcare quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, increase the regularity with which primary care physicians assess people with diabetes mellitus receiving Medicare benefits?

Study design

Cluster randomised controlled trial.

Main results

22, 971 Medicare recipients with diabetes who could be linked with one of 477 study physicians in 123 non-urban counties were identified. The health care quality improvement programme significantly improved monitoring of circulating glycosylated haemoglobin (HbA1c) levels in people with diabetes compared with a no-intervention comparison group (see Table 1). There was no significant difference in number of eye exams or monitoring of urine protein levels between groups.

Table 1 Proportion of people tested with quality indicators at baseline and follow-up.
Quality indicator test	Health care quality improvement programme	Comparison Group	Difference in change from baseline between intervention and control groups (95% CI)
	Proportion of people tested at baseline (%)	Proportion of people tested at follow up (%)	Change from baseline to follow up	Proportion of people tested at baseline (%)	Proportion of people tested at follow up (%)	Change from baseline to follow up
HbA1c	34.3	51.1	16.8	37.2	50.2	13.0	4.0 (0.7 to 7.3)
Eye exams	38.9	39.4	0.5	39.3	39.5	0.2	1.0 (-1.1 to 3.1)
Quantitative urine protein	2.8	4.6	1.8	2.7	4.4	1.7	0.1 (-2.1 to 3.0)

Authors’ conclusions

The population-based health care quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, improved care of people with diabetes.