Review: Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes: A Systematic Literature Review

Abstract

The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descriptive analyses were conducted on the associations found, differentiating for study quality and level of analysis. Structure indicators were mostly tested in studies with weak designs, showing no associations with surrogate outcomes or mixed results. Process indicators focusing on intensification of drug treatment were significantly associated with better surrogate outcomes in three high-quality studies. Process indicators measuring numbers of tests or visits conducted showed mostly negative results in four high-quality studies on surrogate and hard outcomes. Studies performed on different levels of analysis and studies of lower quality gave similar results. For many widely used quality indicators, there is insufficient evidence that they are predictive of better patient outcomes.

Association Between Performance Measures and Glycemic Control Among Patients With Diabetes in a Community-wide Primary Care Cohort

“…21 Although one would expect a relationship between annual monitoring and glycemic control, one should be aware that this will only occur when treatment of patients with elevated HbA1c level is subsequently improved or when patients with adequate levels deteriorate without annual monitoring. We observed a stronger predictive value for annual HbA1c monitoring on glycemic control in patients with elevated baseline levels.…”

“…The association between HbA1c monitoring and glycemic control has been tested, [17][18][19][20] but the results are inconclusive. 21 As these measures include all diabetes patients in the denominator, variations in the study population may influence the outcomes. There is no consensus on the recommended frequency of testing.…”

“…21 In recent years, treatment intensification measurements have been proposed as more meaningful performance measures. 9,15,23 They measure clinical action by assessing whether medication has been started or intensified in patients with elevated HbA1c levels.…”

Is the quality of data in an electronic medical record sufficient for assessing the quality of primary care?

“…There are different studies suggesting that either process or outcome indicators are most important for assessing clinical outcomes. [32][33][34][35][36][37][38][39] The results of this study provide more confidence in outcome than in process indicators from EMR. Regarding the validity of the indicators, we noticed that some outcome indicators could be improved.…”

Change in Quality Management in Diabetes Care Groups and Outpatient Clinics After Feedback and Tailored Support

“…Until now, whether a good QM system results in better process and outcome measures remains unclear. A meta-analysis of quality improvement strategies showed that interventions upon the entire system of chronic disease management were associated with improvements in (surrogate) patient outcomes (5), whereas a systematic review found that the structure of diabetes care was not associated with (surrogate) patient outcomes (25). The present study is the first to provide some insight into QM on an organizational level, but future study to explore the association between QM and patient outcomes is warranted.…”