A COMPREHENSIVE SYSTEM FOR QUALITY IMPROVEMENT IN AMBULATORY CARE - ASSESSING THE QUALITY OF DIABETES CARE

A comprehensive state-of-the-art system for quality improvement in amb ulatory care has been designed to test (1) whether patients at 8 inter vention sites demonstrate improved health status and satisfaction with their care as compared to patients at 8 control sites and (2) the ext ent to which timely patient self-reported data influences provider pra ctice patterns, During the study pilot period, several investigators d eveloped, tested and analyzed disease-specific questionnaires for 7 co mmon chronic conditions. An advanced automated information system was designed to link hospital computer information and patient questionnai re data in order to provide timely communication between patients and providers about important health problems. This report briefly describ es the 3-year quality of ambulatory care clinical trial and details th e development and pilot testing of the disease specific questionnaire for diabetes. Reliability testing showed correlations were higher for fixed events such as foot ulcers than for subjective judgments such as satisfaction with providers. Responsiveness testing indicated that th is questionnaire could measure behavior and care modifications in pati ents 6 months following an outpatient education course, compared to th e baseline pre-education values. Diabetes severity information has bee n collected from self-administered questionnaires and laboratory data to assist providers in assessing the patients' likelihood of 4-year mo rtality. It is anticipated that the rapid identification of important patient issues will assist patients and clinicians in mutually address ing and resolving health care problems, thereby improving the quality of outpatient care.