A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.

<h4>Background</h4>Performance indicators assessing quality of diabetes care often look at single processes, e.g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways). We assessed quality of diabe...

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Autores principales:	Grigory Sidorenkov, Flora M Haaijer-Ruskamp, Dick de Zeeuw, Petra Denig
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7308650457914831ad9c29d66bd5e6d9
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spelling	oai:doaj.org-article:7308650457914831ad9c29d66bd5e6d92021-11-04T06:09:03ZA longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.1932-620310.1371/journal.pone.0024278https://doaj.org/article/7308650457914831ad9c29d66bd5e6d92011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21931669/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Performance indicators assessing quality of diabetes care often look at single processes, e.g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways). We assessed quality of diabetes care by looking at single processes versus clinical pathways. In addition, we evaluated the impact of time period definitions on this quality assessment.<h4>Methodology</h4>We conducted a cohort study in 2007-2008 using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment) database. Proportions of patients adequately managed for HbA1c, systolic blood pressure (SBP), LDL-cholesterol (LDL-C), and albumin/creatinine ratio (ACR) were calculated for the pathway of (1) risk factor level testing, (2) treatment intensification when indicated, (3) response to treatment evaluation. Strict and wide time periods for each step were defined. Proportions of patients adequately managed regarding the overall pathway and single steps, using strict or wide time periods were compared using odds ratios (OR) with 95% confidence intervals.<h4>Findings</h4>Of 11,176 patients diagnosed with type 2 diabetes, 9439 with complete follow-up were included. The majority received annual examination of HbA1c (86%) and SBP (86%), whereas this was 67% for LDL-C and 49% for ACR. Adequate management regarding the three-step pathway was observed in 73%, 53%, 46%, 41% of patients for HbA1c, SBP, LDL-C, and ACR respectively. Quality scores reduced significantly due to the second step (OR 0.43, 0.18, 0.44, 0.74), but were not much further reduced by the third step. Timely treatment evaluation occurred in 88% for HbA1c, 87% for SBP, 83% for LDL-C, and 76% for ACR. The overall score was not significantly changed by using strict time windows.<h4>Conclusion</h4>Quality estimates of glycemic, blood pressure and cholesterol management are substantially reduced when looking at clinical pathways as compared to estimates based on commonly used simple process measures.Grigory SidorenkovFlora M Haaijer-RuskampDick de ZeeuwPetra DenigPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 9, p e24278 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Grigory Sidorenkov Flora M Haaijer-Ruskamp Dick de Zeeuw Petra Denig A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
description	<h4>Background</h4>Performance indicators assessing quality of diabetes care often look at single processes, e.g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways). We assessed quality of diabetes care by looking at single processes versus clinical pathways. In addition, we evaluated the impact of time period definitions on this quality assessment.<h4>Methodology</h4>We conducted a cohort study in 2007-2008 using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment) database. Proportions of patients adequately managed for HbA1c, systolic blood pressure (SBP), LDL-cholesterol (LDL-C), and albumin/creatinine ratio (ACR) were calculated for the pathway of (1) risk factor level testing, (2) treatment intensification when indicated, (3) response to treatment evaluation. Strict and wide time periods for each step were defined. Proportions of patients adequately managed regarding the overall pathway and single steps, using strict or wide time periods were compared using odds ratios (OR) with 95% confidence intervals.<h4>Findings</h4>Of 11,176 patients diagnosed with type 2 diabetes, 9439 with complete follow-up were included. The majority received annual examination of HbA1c (86%) and SBP (86%), whereas this was 67% for LDL-C and 49% for ACR. Adequate management regarding the three-step pathway was observed in 73%, 53%, 46%, 41% of patients for HbA1c, SBP, LDL-C, and ACR respectively. Quality scores reduced significantly due to the second step (OR 0.43, 0.18, 0.44, 0.74), but were not much further reduced by the third step. Timely treatment evaluation occurred in 88% for HbA1c, 87% for SBP, 83% for LDL-C, and 76% for ACR. The overall score was not significantly changed by using strict time windows.<h4>Conclusion</h4>Quality estimates of glycemic, blood pressure and cholesterol management are substantially reduced when looking at clinical pathways as compared to estimates based on commonly used simple process measures.
format	article
author	Grigory Sidorenkov Flora M Haaijer-Ruskamp Dick de Zeeuw Petra Denig
author_facet	Grigory Sidorenkov Flora M Haaijer-Ruskamp Dick de Zeeuw Petra Denig
author_sort	Grigory Sidorenkov
title	A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
title_short	A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
title_full	A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
title_fullStr	A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
title_full_unstemmed	A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
title_sort	longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/7308650457914831ad9c29d66bd5e6d9
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A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.

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