Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain

Abstract

Aims: To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia.

Methods: Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals.

Results: Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed.

Conclusions: Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.

Figure 1

(A) Process indicators: HbA_1c, total cholesterol and blood pressure. Percentage of patients with at least one annual measurement. (B) Process indicators: complications screening. Percentage of patients with annual foot exploration, fundus examination and albuminuria screening. (C) Intermediate outcome indicators: percentage of patients with acceptable control of HbA_1c, total cholesterol and blood pressure. Equivalencies: 250mg/dl = 6.47 mmol/l; 8% = 68 mmol/mol. (D) Intermediate outcome indicators: percentage of patients with strict control of HbA_1c, total cholesterol and blood pressure. Equivalencies: 200mg/dl = 5.17 mmol/l; 7% = 57 mmol/mol