Five-year impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics

OBJECTIVE— To evaluate the impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics in Sicily, Italy. RESEARCH DESIGN AND METHODS— Twenty-two clinics adopted the same electronic medical record system. Process and intermediate outcomes indicators were identified and software was developed, enabling the extraction of the information needed for the profiling of quality of care. Data were centrally analyzed anonymously every year, and results were discussed in meetings with the participants. The performances of the different centers were ranked against the “best performers,” and the reasons for variation were discussed. RESULTS— From 2001 to 2005, a total of 26,782 patients aged18 years have been seen in the participating clinics. Rates of monitoring of A1C, blood pressure, lipid profile, and microalbuminuria constantly increased over the years. The percentage of individuals with A1C values 7.0% increased by 16.6%, while the proportion of patients with blood pressure 130/85 mmHg increased by 10.7%. The percentage of individuals with LDL cholesterol levels 100 mg/dl had a marked increase from 19.4 to 44.1%. Rates of use of lipid-lowering drugs, antihypertensive drugs, and aspirin also substantially raised over the years. CONCLUSIONS— We found a strong consistency between increasing rates of monitoring, increasing drug prescription, and better levels of intermediate outcomes. Despite the satisfactory achievements, a substantial room for improvement in the care of diabetes still persists.