Patients and nurses determine variation in adherence to guidelines at Dutch hospitals more than internists or settings

Abstract

More focus on patient involvement in diabetic care and the contribution of diabetes specialist nurses may be important factors in improving the quality of diabetes care.

Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level

“…Prior research shows that physician effects could be influential. [35][36][37][38] However, we were unable to identify physicians in our study.…”

“…A systematic review 34 finds the proportion of variance in health care quality measures explained by facility-level effects was between 0% and 51%. Prior studies 35,36 specifically examining diabetes process measures found that the variance attributable to facility effects was < 20%. For example, Krein and colleagues found that facility factors explained 9% of the variation in the percentage of patients within a facility who had at least 1 HbA1c measure obtained in the past year.…”

Overall quality of diabetes care in a defined geographic region: different sides of the same story

“…The findings of the present study regarding the quality of diabetes care in both general practice and outpatient clinic are in line with those of other studies performed in the Netherlands. [15][16][17][18] Consequently, the results of this study can be considered representative for the quality of diabetes care in the Netherlands.…”

Quality in primary care

“…1 This is consistent with the few other studies that have rigorously examined variation in outcome at both individual and institutional level, 3 suggesting, for example, that blood pressure measurement for patients with diabetes varies more between doctors but organisationally complex processes such as eye screening vary more between hospitals. 4 The study also found that doctors' scores for communication varied more in practices where the average score was low, leading to the conclusion that "higher performing practices usually contain only higher performing doctors" whereas "lower performing practices may contain doctors with a wide range of communication scores." 1 This conclusion is perhaps contentious since the paper does not report whether any of the practices or doctors were statistically significantly above or below average in their performance.…”