Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals
Annals of Internal Medicine (07/12/16) Ali, Mohammed K.; Singh, Kavita; Kondal, Dimple
In this study, researchers sought to compare the effect of a multicomponent quality improvement (QI) strategy with usual care on cardiometabolic profiles in patients with poorly controlled diabetes. The parallel, open-label trial was conducted at diabetes clinics in India and Pakistan. The study included more than 1,100 patients with type 2 diabetes and poor cardiometabolic profiles, randomized to a multicomponent QI strategy with nonphysician care coordinators and decision-support health records or to usual care. The median diabetes duration was seven years, and 6.8 percent and 39.4 percent of participants had pre-existing cardiovascular and microvascular disease, respectively. Over a median of 28 months, a greater percentage of patients in the intervention group achieved the primary outcome of HbA1c level less than 7 percent plus blood pressure (BP) less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL. Furthermore, the intervention participants had greater reductions in HbA1c level, systolic BP, diastolic BP, and LDLc level and reported higher health-related quality of life and treatment satisfaction, compared with the control group. The findings indicate that even in resource-challenged settings, multicomponent QI can improve achievement of diabetes care objectives.
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