Diabetes care may be improved with Steno Quality Assurance Tool—A self-assessment tool in diabetes management

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Abstract

To evaluate if improvements in the quality of diabetes care in Indian clinics can be obtained by simple self-surveillance PC-based software.

Method

Nineteen Indian diabetes clinics were introduced to the principles of quality assurance (QA), and to a software program, the Steno Quality Assurance Tool (SQAT). Data was entered for an initial 3 months period. Subsequently data were analyzed by the users, who designed plans to improve indicator status and set goals for the upcoming period. A second data entry period followed after 7–9 months.

Results

QA data was analyzed from 4487 T2DM patients (baseline) and 4440 (follow-up). The average examination frequency per clinic of the following indicators increased significantly: lipid examination (72–87%) (p = 0.007), foot examination (80–94%) (p = 0.02), HbA1c investigation (59–77%) (p = 0.006), and urine albumin excretion investigation (72–87%) (p = 0.006). Outcome parameters also improved significantly: mean (SD) fasting and post prandial BG reduced from 144(16) to 132(16) mg/dl (p = 0.02) and 212(24)–195(29) mg/dl (p = 0.03), respectively. Systolic BP reduced from 139(6) to 133(4) (p = 0.0008) mmHg and diastolic BP from 83(3) to 81(3) mmHg (p = 0.002).

Conclusion

Quality of diabetes care can be improved by applying SQAT, a QA self-surveillance software that enables documentation of changes in process and outcome indicators.

Section snippets

Background

Diabetes is a worldwide, fast rising epidemic where quality of treatment is far from acceptable: A recent study across four continents easily recruited more than 66,000 people with diabetes in poor metabolic control with an average HbA1c of 9.5% (80 mmol/mol) [1]. Steno-2, UKPDS and other studies have provided evidence, that intervention against risk factors reduces micro- and macro-vascular complications [2], [3]. Guidelines are almost universally available and offer assistance for the

Selection of indicators

A selected list of indicators was reviewed by 30 Indian key opinion leaders in diabetology. Seven of these formed an advisory Board for the development of the SQAT software.

The following process and outcome indicators were selected: BMI, glycaemic control HbA1c, fasting or postprandial blood glucose, systolic and diastolic blood pressure, urine albumin excretion measured, whether albuminuria was present, date of last foot and eye examination, and date of last lipid measurement. Type of

Statistics

Mean changes has been calculated for each process indicator per clinic in period 1 and period 2, and compared by means of Wilcoxon test (paired), whereas means per clinic for continuous measures, outcome indicators, in period 1 and period 2 have been compared by Paired Student T test, as has achievement of outcome goals glycaemic control: HbA1c  7% (53 mmol/mol) or FBG  6.5 mmol/l (117 mg/dl) or PPG  10 mmol/l (180 mg/dl), blood pressure  130/80 mmHg

A significance level of 5% was used.

Results

Twenty-three clinics completed the first data entry period, and nineteen completed the second data entry period. Only data from the 19 clinics entering data from both periods are presented. The clinics entered data for 4487 patients for period one and 4440 patients for period two. Mean number (range) entered per clinic in the two periods were 470 (167–1031) patients. Mean age (range) across clinics was 54.2 years (53.9–54.4). The gender distribution was 44.2% women and 55.8% men. Mean diabetes

Discussion

This study demonstrates that self-assessment of clinical quality in diabetes care using a bottom-up approach by means of a simple computer based software enables smaller and medium-sized Indian diabetes clinics to improve selected diabetes process and outcome indicators. It supports our hypothesis that a structured approach to diabetes treatment and the possibility to analyze own data will contribute to the overall improvement of clinical care.

The data entered in the first entry period

Conclusion

Diabetes care can be improved by applying SQAT as a QA self-surveillance software program that documents the changes in process and outcome indicators.

Conflict of interest statement

The authors declare that there are no conflicts of interests.

References (25)

  • Society for quality in health care,...
  • National commity for quality assurance,...
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    1

    See Appendix A for SQUAT Study Group.

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