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Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial.

Publication Type : Journal Article

Thematic Areas : Medical Sciences

Publisher : Ann Intern Med.

Source : Ann Intern Med, Volume 165, Issue 6, p.399-408 (2016)

Keywords : Blood pressure, Cholesterol, LDL, Decision Support Systems, Clinical, Diabetes Mellitus, Type 2, Electronic Health Records, female, Follow-Up Studies, Glycated Hemoglobin A, Humans, India, male, middle aged, Pakistan, Patient Care Team, Quality improvement, quality of life, Risk Factors, treatment outcome

Campus : Kochi

School : School of Medicine

Year : 2016

Abstract : BACKGROUND: /bAchievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia./ppbOBJECTIVE: /bTo compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes./ppbDESIGN: /bParallel, open-label, pragmatic randomized, controlled trial. ( NCT01212328)./ppbSETTING: /bDiabetes clinics in India and Pakistan./ppbPATIENTS: /b1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL)./ppbINTERVENTION: /bMulticomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records./ppbMEASUREMENTS: /bProportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes)./ppbRESULTS: /bBaseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction./ppbLIMITATION: /bFindings were confined to urban specialist diabetes clinics./ppbCONCLUSION: /bMulticomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics./ppbPRIMARY FUNDING SOURCE: /bNational Heart, Lung, and Blood Institute and UnitedHealth Group.

Cite this Research Publication : M. K. Ali, Singh, K., Kondal, D., Devarajan, R., Patel, S. A., Shivashankar, R., Ajay, V. S., Unnikrishnan, A. G., V Menon, U., Varthakavi, P. K., Viswanathan, V., Dharmalingam, M., Bantwal, G., Sahay, R. Kumar, Masood, M. Qamar, Khadgawat, R., Desai, A., Sethi, B., Prabhakaran, D., Narayan, K. M. Venkat, and Tandon, N., “Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial.”, Ann Intern Med, vol. 165, no. 6, pp. 399-408, 2016.

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