CONTINUOUS QUALITY IMPROVEMENT CAN IMPROVE GLYCEMIC CONTROL FOR HMO PATIENTS WITH DIABETES

Objective: To evaluate the impact of a continuous quality improvement (CQI) intervention on glycemic control of patients with diabetes melli tus attending a primary care clinic. Methods: A CQI process designed b y the Minnesota Department of Health to improve diabetes care was impl emented at a volunteer clinic, with another similar clinic not using t he CQI process assessed for comparison. Adults with diabetes were iden tified al: both clinics using diagnostic and pharmacy databases. Glyco sylated hemoglobin (HbA(1c)) values (reference range, 4.3%-6.1%) and o utpatient utilization and charges were compared for all patients with diabetes at each clinic for the 12 months before and 18 months after i nitiation of the CQT intervention. Results: The mean HbA(1c) value at the intervention clinic fell from 8.9% at baseline to 8.4% at 12 month s and to 7.9% at 18 months. The mean HbA(1c) value at the comparison c linic was 8.9% at baseline, 8.9% at 12 months, and 8.8% at 18 months ( difference between clinics, t=4.13, P<.001). Differences after the int ervention in the proportion of patients at the comparison clinic (n=12 1) vs the intervention clinic (n=122) with HbA(1c) values of 8% or les s (40% vs 51%), between 8% and 10% (33% vs 37%); and 10% or greater (2 7% vs 12%) were unlikely due to chance (X(2)=9.7, 2 df, P=.008). The i ntervention was not associated with increased utilization of outpatien t visits or outpatient charges. Conclusions: Involvement of nurses, ph ysicians, and managers in a CQI process can improve patients' glycemic control in some health maintenance organization primary care settings , without increasing utilization or charges. Health maintenance organi zations should consider CQI as one possible method to improve diabetes outcomes.