The Agency for Healthcare Research ...

The Agency for Healthcare Research and Quality (AHRQ) of the U Department of Health and Human Services has released a technical review in succession improving the quality of health care for adult patients with symbol 2 diabetes mellitus. "Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. compass 2--Diabetes Mellitus Care" was released in September 2004 as AHRQ Publication No. 04-0051-2 and is available online at http://www.ahrq.gov/clinic/evrptpdfs.htm#qualgap2.

Diabetes affects more than 17 million the community in the United States, and, factoring in undiagnosed cases of diabetes and impaired grape-sugar tolerance, one in seven Americans either has diabetes or is at high risk for developing it. According to the authors, the quality of care for patients with diabetes is les than optimal because many of these patients are not receiving established processe of care (eg organ of vision and foot screening) or achieving optimal consequences (e.g., controlled hemoglobin A1C levels)

The researchers searched the MEDLINE database, the Cochrane Collaboration's Effective Practice and Organisation of Care registry, article bibliographies, and relevant journals for experimental evaluation of quality-improvement interventions in the outpatient care of adults with sign 2 diabetes mellitus.

Quality-improvement targets included measures of disease superintendence (e.g., serum A1C levels, kin pressure) and physician adherence (eg serial monitoring of A1C on a levels control of hypertension, management of cardiovascular risk factors). The researchers ground 58 articles reporting a total of 66 trials that met the established inclusion criteria. The most numerous common quality-improvement interventions tested in these studies were organizational change (40 trials), patient education (28 trials), and physician education (24 trials). Fifty-two trials involved interventions that used more than undivided quality-improvement strategy.

The researchers did not find any strategy to be unambiguously beneficial in the care of patients with diabetes. The physician-education strategy produc large median results for glycemic control and physician adherence, further the findings were of merely borderline significance. Interventions that used case- or disease-management strategies flowed in significantly greater median reductions in serum A1C flushs compared with interventions that lacked a component part of disease management; however, this tend did not reach statistical significance. All of the other quality-improvement strategies that were evaluated failed to improve serum A1C flats or physician adherence to an appreciable reach In the larger randomized trials, employing more than single quality-improvement strategy appeared to be more beneficial than single- faceted interventions; however, the small number of studies limits the reliability of this finding.

Overall, the review erect that multifaceted interventions may be more likely than single-faceted interventions to have positive purports on glycemic control and physician adherence. However, the conclusions are limited on probable publication bias favoring smaller trials and nonrandomized trials, and the carriage of multiple quality-improvement strategies in a given intervention.

COPYRIGHT 2005 American Academy of Family Physicians

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