1205-P: Diabetes Medical Care Quality Index (ICAD): A Nationwide Experience of Continuous Improvement in Primary Health Care Clinics

Abstract

Digital health and robust analytics have shown to improve the quality of care by enabling data-driven decision making and accurate allocation of resources. Due to the fast-growing burden of T2D in Mexico, we created the Diabetes Medical Care Quality Index (ICAD) to favor the continuous improvement of care in primary healthcare clinics (PHC).The ICAD assesses three components: patient retention (PR), adherence with clinical guidelines (ACG), and T2D control (DMC) through a 100-point score, to estimate the percentage of patients that regularly visit their clinic, the medical actions provided each visit, and the percentage of patients with A1c <7%, respectively. We monthly computed ICAD of 9,958 Mexican PHC from June 2016 to October 2018 through the NCDs Information System (SIC) with up to 537,752 T2D patients. In June 2016, the national ICAD score was 54.6, with PR of 46.6, ACG of 69.9, and DMC of 40.9. As of October 2018, after monthly emailing ICAD to each clinic in a meaningful and transparent performance report, we found a significant increase in ICAD overall score and its components: ICAD of 66.0 (+21.0% p<0.001); PR of 64.0 (+37.4% p<0.001), ACG of 79.3 (+13.5% p<0.001), and DMC of 60.0 (+24.7% p<0.001).When compared to data collected through the National Infrastructure Inventory, we found that the major determinants related to the improvement of the ICAD are: community screening programs (β = 4.06 95%CI 3.50-4.62), availability for CBG testing (β=3.08, 95%CI 2.83-3.34) and A1c point of care testing (β =2.52 95% CI 2.40-2.63); availability of insulin (β=3.05 95%CI 2.94-3.16) and oral hypoglycemic drugs (β=1.51 95%CI 1.40-1.63), as well as online continuing medical education for providers (β=0.92, 95%CI 0.79-1.1) and IT infrastructure (β=0.57, 95%CI 0.44-0.72). In sum, we creates, measured and systematically communicated ICAD, enabling interventions in PHC that improved the quality of care and health outcomes for T2D patients. Disclosure H. Gallardo: None. L. Suarez-Idueta: None. J. Lomelin-Gascon: Other Relationship; Self; Lilly Global Health Partnership. A. Montoya: None. R. Mujica-Rosales: None. R.C. Tapia-Conyer: None. E.R. Saucedo-Martinez: None.