Benchmarking is associated with improved quality of care in type 2 diabetes: the OPTIMISE randomized, controlled trial

Abstract

Objective: To assess prospectively the effect of benchmarking on quality of primary care for patients with type 2 diabetes by using three major modifiable cardiovascular risk factors as critical quality indicators.

Research design and methods: Primary care physicians treating patients with type 2 diabetes in six European countries were randomized to give standard care (control group) or standard care with feedback benchmarked against other centers in each country (benchmarking group). In both groups, laboratory tests were performed every 4 months. The primary end point was the percentage of patients achieving preset targets of the critical quality indicators HbA1c, LDL cholesterol, and systolic blood pressure (SBP) after 12 months of follow-up.

Results: Of 4,027 patients enrolled, 3,996 patients were evaluable and 3,487 completed 12 months of follow-up. Primary end point of HbA1c target was achieved in the benchmarking group by 58.9 vs. 62.1% in the control group (P = 0.398) after 12 months; 40.0 vs. 30.1% patients met the SBP target (P < 0.001); 54.3 vs. 49.7% met the LDL cholesterol target (P = 0.006). Percentages of patients meeting all three targets increased during the study in both groups, with a statistically significant increase observed in the benchmarking group. The percentage of patients achieving all three targets at month 12 was significantly larger in the benchmarking group than in the control group (12.5 vs. 8.1%; P < 0.001).

Conclusions: In this prospective, randomized, controlled study, benchmarking was shown to be an effective tool for increasing achievement of critical quality indicators and potentially reducing patient cardiovascular residual risk profile.

Trial registration: ClinicalTrials.gov NCT00681850.

Figure 1

Patient disposition.

Figure 2

Percentages of patients reaching critical quality indicator targets at baseline and after 12 months of follow-up. A: HbA_1c target <7.0% (<53.0 mmol/mol). B: SBP target <130 mmHg (<125 mmHg in patients with proteinuria). C: LDL cholesterol target <100 mg/dL (<80 mg/dL in Belgium; <70 mg/dL in patients with existing CHD). D: Percentages of patients reaching target for all three critical quality indicators.