A multicomponent quality improvement (QI) strategy comprised of nonphysician care coordinators and decision-support electronic health records can help to improve achievement of diabetes care goals, even in resource-challenged clinics. Findings from the randomized, controlled trial are published in Annals of Internal Medicine.
Diabetes is one of the most prevalent and burdensome chronic disease worldwide. Diabetes management focuses on reducing patients' risk for complications through control of blood glucose levels, blood pressure, and lipid levels, and avoidance of tobacco. However, large gaps exist between achievement of care goals and actual practice worldwide. QI interventions directed at patients (reminders), providers (guideline prompts), and health systems (institutionalizing a "culture of quality") can improve adherence, risk factor control, and patient satisfaction, but has not been tested in South Asia.
Researchers compared the effect of a multicomponent diabetes QI strategy versus usual care in South Asia, where resources are limited and diabetes is prevalent. Approximately 1,150 patients with diabetes and poor cardiometabolic profiles were randomly assigned to a multicomponent QI strategy or usual care for 2.5 years. They found that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared with usual care. The authors suggest that implementation of multicomponent QI strategies could help to preserve quality of life for millions of diabetes sufferers.
Article: Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial, Mohammed K. Ali, MBChB, MSc, MBA; Kavita Singh, MSc; Dimple Kondal, PhD; Raji Devarajan, MSc; Shivani A. Patel, MPH, PhD; Roopa Shivashankar, MD; Vamadevan S. Ajay, MPH, PhD; A.G. Unnikrishnan, MD, DM; V. Usha Menon, PhD; Premlata K. Varthakavi, MD, DNB; Vijay Viswanathan, MD, PhD; Mala Dharmalingam, MD, DM; Ganapati Bantwal, MD, DM; Rakesh Kumar Sahay, MD, DM; Muhammad Qamar Masood, MBBS; Rajesh Khadgawat, MD, DM; Ankush Desai, MD, DM; Bipin Sethi, MD, DM; Dorairaj Prabhakaran, MD, DM; K.M. Venkat Narayan, MD; Nikhil Tandon, MD, PhD, on behalf of the CARRS Trial Group, Annals of Internal Medicine, doi: 10.7326/M15-2807, published online 12 July 2016.