Multifaceted quality improvement intervention in primary care practices benefits diabetes outcomes, findings show

A multicomponent organizational intervention in the primary care setting has the potential to significantly increase the percentage of patients with type 2 diabetes who achieve recommended clinical goals, a new study concludes. To determine whether such an intervention could produce significant change in diabetes care and outcomes in community primary care practices, researchers randomized 24 community primary care practices to receive either the intervention or a control condition (a...

A multicomponent organizational intervention in the primary care setting has the potential to significantly increase the percentage of patients with type 2 diabetes who achieve recommended clinical goals, a new study concludes.

To determine whether such an intervention could produce significant change in diabetes care and outcomes in community primary care practices, researchers randomized 24 community primary care practices to receive either the intervention or a control condition (a report of process and outcome measures at baseline and encouragement to continue usual quality improvements).

The intervention included implementation of an electronic diabetes registry, visit reminders, and patient-specific physician alerts. In addition, a site coordinator facilitated both previsit planning and a monthly review of performance with a local physician assigned to act as program advocate (ie, a "local physician champion"). Work flow changes in the intervention group included identification and case management of patients not achieving goals, provider alerts with integrated decision support during visits, and monthly reviews by the local physician champion with feedback to individual providers, the researchers noted.

The researchers evaluated the percentages of patients achieving target values for systolic blood pressure (SBP <130 mmHg), low-density lipoprotein (LDL) cholesterol (LDL cholesterol <100 mg/dL), and hemoglobin A1C (A1C <7%). They also evaluated improvements in rates of 6 process measures: blood pressure monitoring, renal testing, annual eye examinations, foot examinations, A1C testing, and LDL cholesterol testing.

Twelve months after the researchers introduced the multicomponent intervention program, primary care practices in the intervention group improved significantly more than control practices in their ability to help patients with diabetes achieve recommended clinical targets.

Both groups achieved significant declines in mean SBP and LDL cholesterol levels, but only the intervention group achieved significant declines in A1C (P<.02) in analyses adjusted for age, sex, and comorbidity. Intervention practices also had significantly higher proportions of patients who achieved target levels for SBP (45.0% vs 40.6%; P<.001), LDL cholesterol (43.0% vs 35.5%; P<.001), and A1C (49.0% vs 43.8%; P<.001).

At 12 months, the net improvement in the average number of recommended clinical targets (SBP, LDL cholesterol, and A1C) achieved from baseline to 12 months among all patients was significantly greater among the intervention practices than among the control practices (P=.002).

In addition, from the 12-month period before the intervention to the 12-month period following its implementation, intervention practices showed significantly greater improvement in rates of all 6 process measures as compared with control practices.

"This combination of components provides a proven strategy for initiating improvement in clinical diabetes care for many primary care practices," concluded the authors. (Peterson KA, et al. Diabetes Care 2008;31:2238–2243.)