Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics

Rossi, Maria Chiara; Nicolucci, Antonio; Arcangeli, A.; Cimino, Antonino; Bigontina, Gualtiero De; Giorda, Carlo; Meloncelli, Illidio; Pellegrini, Fabio; Valentini, Umberto; Vespasiani, G

doi:10.2337/dc08-0469

Cited by 69 publications

(69 citation statements)

References 10 publications

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“…In this respect, we extend previous evidence limited to process indicators obtained in the setting of specialized clinics (4), pointing out widespread inadequacy of care provided by both diabetes clinics and GPs.…”

supporting

confidence: 76%

Quality of Diabetes Care in Italy: Information From a Large Population-Based Multiregional Observatory (ARNO Diabetes)

et al. 2012

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supporting

confidence: 76%

Quality of Diabetes Care in Italy: Information From a Large Population-Based Multiregional Observatory (ARNO Diabetes)

et al. 2012

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“…Yet control of multiple risk factors often remains suboptimal (4,176) leading to poor outcomes. Nearly 95% of the complex tasks for self-management fall upon patients themselves (177), yet most patients encounter considerable difficulty in following recommended treatments and behaviors.…”

Section: Treatment Of Hypertension and Dkdmentioning

confidence: 99%

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

Tuttle

Bakris

Bilous

et al. 2014

American Journal of Kidney Diseases

657

604

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The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.

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“…In Italy, a continuous improvement effort implemented by a network of diabetes clinics has been promoted since 2006 (12,13). The initiative, which involves approximately one-third of all the diabetes outpatient clinics operating within the national health care system, allows the monitoring of a large set of process and outcome indicators and the use of specific classes of drugs, with the aim of examining strengths and limitations of the current diabetes care.…”

mentioning

confidence: 99%

Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes

et al. 2013

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OBJECTIVETo investigate the quality of type 2 diabetes care according to sex.RESEARCH DESIGN AND METHODSClinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated.RESULTSOverall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c >9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10–1.17]), 42% more likely to have LDL cholesterol (LDL-C) ≥130 mg/dL (1.42 [1.38–1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 kg/m2 (1.50 [1.50–1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure.CONCLUSIONSWomen show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.

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Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics

Cited by 69 publications

References 10 publications

Quality of Diabetes Care in Italy: Information From a Large Population-Based Multiregional Observatory (ARNO Diabetes)

Quality of Diabetes Care in Italy: Information From a Large Population-Based Multiregional Observatory (ARNO Diabetes)

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes

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