Process measures and outcome research as tools for future improvement of diabetes treatment quality

Abstract 

Objective: Good metabolic control, careful monitoring of late diabetic complications and early intervention against cardiovascular risk factors improve the prognosis in Type 1 and Type 2 diabetic patients. The aim of the present study was to analyse the treatment quality in a routine outpatient clinic. Design: A descriptive survey of unselected outpatient Type 1 diabetic patients followed from 1995 to 1997. Setting: The outpatient clinic at Steno Diabetes Center, Denmark. Subjects: 2011 unselected Type 1 diabetic patients, representatives for the County of Copenhagen, Denmark. Main outcome measures: Levels of metabolic control, screening frequencies for late diabetic complications and cardiovascular risk factors. Results: The mean age (SD) and diabetes duration of the patients were 49 (16) (SD) and 20 (13) years, respectively, and 54% of the patients were males. Glycosylated haemoglobin A_1c (HbA_1c) was measured at least once yearly in >99.5% of the patients, and the annual number of measurements was 3 pt⁻¹. The mean HbA_1c (normal 4.1–6.4%) was 8.8, 8.7 and 8.6% in 1995, 1996, 1997, respectively. The frequency of HbA_1c<140% of the non-diabetic mean (HbA_1c<7.5%) was 14.6, 15.4 and 17.7% in the 3 years (P<0.05). Urinary albumin excretion was measured in 87.0, 87.1 and 80.5%, and blood pressure in 71.4, 76.7 and 79.8% in the 3 years, respectively. In the 3-year period, foot examination and fundus photography were performed at least once in 84.7 and 88.6%, respectively. Conclusions: in unselected Type 1 diabetic patients followed at the outpatient clinic at Steno Diabetes Center, only some, but not all, important clinical variables are measured at high frequency despite standard operation procedures. Continuous collection of data may help to explain why there is such a difference.

Keywords:  Outcome data, Quality of care, Type 1 diabetes mellitus, HbA_1c, Urinary albumin excretion