Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

Meier, Rahel; Valeri, Fabio; Senn, Oliver; Rosemann, Thomas; Chmiel, Corinne

doi:10.1371/journal.pone.0232686

Cited by 12 publications

(12 citation statements)

References 36 publications

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“…Our observations are close to those of high-ranking countries, apart from the prevalence of foot examination in the “GP only” profile, which is substantially lower than European findings. We found that the proportion of participants reporting HbA1c, blood cholesterol and BP measurement was >80%, which is consistent with observations made in Europe, but higher than previous findings in Switzerland, especially regarding cholesterol testing ( 3 , 40 – 43 ). The prevalence of influenza immunization in our sample is comparable to observations recently reported in Spain, the United Kingdom and the USA ( 44 – 46 ).…”

Section: Discussionsupporting

confidence: 91%

“…The prevalence of influenza immunization in our sample is comparable to observations recently reported in Spain, the United Kingdom and the USA ( 44 – 46 ). Our results confirm that processes of care included in composite indicators are rarely all fulfilled as reported in a Swiss study showing that only 17.2% of the participants achieved the six quality indicators used to assess performance ( 43 ). The lower prevalence of several processes of care in the “GP only” profile seems to corroborate past research, which found that specialty care, alone or in addition to primary care, achieved a better quality than primary care alone ( 4 – 8 , 12 , 13 ).…”

Section: Discussionsupporting

confidence: 87%

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Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study

et al. 2022

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BackgroundDespite the growing burden of diabetes worldwide, evidence regarding the optimal models of care to improve the quality of diabetes care remains equivocal. This study aimed to identify profiles of patients with distinct ambulatory care use patterns and to examine the association of these profiles with the quality of diabetes care.MethodsWe performed a cross-sectional study of the baseline data of 550 non-institutionalized adults included in a prospective, community-based, cohort study on diabetes care conducted in Switzerland. Clusters of participants with distinct patterns of ambulatory healthcare use were identified using discrete mixture models. To measure the quality of diabetes care, we used both processes of care indicators (eye and foot examination, microalbuminuria screening, blood cholesterol and glycated hemoglobin measurement [HbA1c], influenza immunization, blood pressure measurement, physical activity and diet advice) and outcome indicators (12-Item Short-Form Health Survey [SF-12], Audit of Diabetes-Dependent Quality of Life [ADDQoL], Patient Assessment of Chronic Illness Care [PACIC], Diabetes Self-Efficacy Scale, HbA1c value, and blood pressure <140/90 mmHg). For each profile of ambulatory healthcare use, we calculated adjusted probabilities of receiving processes of care and estimated adjusted outcomes of care using logistic and linear regression models, respectively.ResultsFour profiles of ambulatory healthcare use were identified: participants with more visits to the general practitioner [GP] than to the diabetologist and receiving concomitant podiatry care (“GP & podiatrist”, n=86); participants visiting almost exclusively their GP (“GP only”, n=195); participants with a substantially higher use of all ambulatory services (“High users”, n=96); and participants reporting more visits to the diabetologist and less visits to the GP than other profiles (“Diabetologist first”, n=173). Whereas participants belonging to the “GP only” profile were less likely to report most processes related to the quality of diabetes care, outcomes of care were relatively comparable across all ambulatory healthcare use profiles.ConclusionsSlight differences in quality of diabetes care appear across the four ambulatory healthcare use profiles identified in this study. Overall, however, results suggest that room for improvement exists in all profiles, and further investigation is necessary to determine whether individual characteristics (like diabetes-related factors) and/or healthcare factors contribute to the differences observed between profiles.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study

et al. 2022

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“…In the baseline analysis of this RCT, we conducted further investigations to disentangle the complex interplay of different factors influencing quality of care, also including patient characteristics. 40 However, the influence of available explanatory variables of practice, GP, and patient level on performance was surprisingly small. Another potential explanatory variable—not systematically retrieved—is the availability of specifically trained chronic care nurses.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Financial Incentives on Quality Measures in the Treatment of Diabetes Mellitus: a Randomized Controlled Trial

et al. 2021

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Background Financial incentives are often used to improve quality of care in chronic care patients. However, the evidence concerning the effect of financial incentives is still inconclusive. Objective To test the effect of financial incentives on quality measures (QMs) in the treatment of patients with diabetes mellitus in primary care. We incentivized a clinical QM and a process QM to test the effect of financial incentives on different types of QMs and to investigate the spill-over effect on non-incentivized QMs. Design/Participants Parallel cluster randomized controlled trial based on electronic medical records database involving Swiss general practitioners (GPs). Practices were randomly allocated. Intervention All participants received a bimonthly feedback report. The intervention group additionally received potential financial incentives on GP level depending on their performance. Main Measures Between-group differences in proportions of patients fulfilling incentivized QM (process QM of annual HbA1c measurement and clinical QM of blood pressure level below 140/95 mmHg) after 12 months. Key Results Seventy-one GPs (median age 52 years, 72% male) from 43 different practices and subsequently 3838 patients with diabetes mellitus (median age 70 years, 57% male) were included. Proportions of patients with annual HbA1c measurements remained unchanged (intervention group decreased from 79.0 to 78.3%, control group from 81.5 to 81.0%, OR 1.09, 95% CI 0.90–1.32, p = 0.39). Proportions of patients with blood pressure below 140/95 improved from 49.9 to 52.5% in the intervention group and decreased from 51.2 to 49.0% in the control group (OR 1.16, 95% CI 0.99–1.36, p = 0.06). Proportions of non-incentivized process QMs increased significantly in the intervention group. Conclusion GP level financial incentives did not result in more frequent HbA1c measurements or in improved blood pressure control. Interestingly, we could confirm a spill-over effect on non-incentivized process QMs. Yet, the mechanism of spill-over effects of financial incentives is largely unclear. Trial Registration ISRCTN13305645

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“…This study thus closes a gap, left by observational studies. Moreover, the baseline analysis showed that the patient population in this trial was highly comparable to other diabetes populations in Swiss primary care (22)(23)(24).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 81%

Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial

et al. 2021

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Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn.Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records.Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs.Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months.Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months.Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.

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Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

Cited by 12 publications

References 36 publications

Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study

Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study

The Effect of Financial Incentives on Quality Measures in the Treatment of Diabetes Mellitus: a Randomized Controlled Trial

Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial

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