Pj. Oconnor et al., CONTINUOUS QUALITY IMPROVEMENT CAN IMPROVE GLYCEMIC CONTROL FOR HMO PATIENTS WITH DIABETES, Archives of family medicine, 5(10), 1996, pp. 502-506
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.