Abstract
BackgroundIn the context of the DAWN-2 initiatives, the BENCH-D Study aims to test a model of regional benchmarking to improve not only the quality of diabetes care, but also patient-centred outcomes.Methods/DesignAs part of the AMD-Annals quality improvement program, 32 diabetes clinics in 4 Italian regions extracted clinical data from electronic databases for measuring process and outcome quality indicators. A random sample of patients with type 2 diabetes filled in a questionnaire including validated instruments to assess patient-centred indicators: SF-12 Health Survey, WHO-5 Well-Being Index, Diabetes Empowerment Scale, Problem Areas in Diabetes, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Barriers to Medications, Patient Support, Diabetes Self-care Activities, and Global Satisfaction for Diabetes Treatment. Data were discussed with participants in regional meetings. Main problems, obstacles and solutions were identified through a standardized process, and a regional mandate was produced to drive the priority actions. Overall, clinical indicators on 78,854 patients have been measured; additionally, 2,390 patients filled-in the questionnaire. The regional mandates were officially launched in March 2012. Clinical and patient-centred indicators will be evaluated again after 18 months. A final assessment of clinical indicators will take place after 30 months.DiscussionIn the context of the BENCH-D study, a set of instruments has been validated to measure patient well-being and satisfaction with the care. In the four regional meetings, different priorities were identified, reflecting different organizational resources of the different areas. In all the regions, a major challenge was represented by the need of skills and instruments to address psychosocial issues of people with diabetes. The BENCH-D study allows a field testing of benchmarking activities focused on clinical and patient-centred indicators.
Highlights
The prevention of diabetes and control of its micro- and macrovascular complications has become one of the main public health challenges for the 21st century, with the aim of attaining a significant reduction in the huge premature morbidity and mortality it causes, with a parallel reduction in health care costs (Shaw et al 2010)
The use of WHO-5 well-being index (WHO-5) is recommended in global and some national treatment guidelines for diabetes after its worldwide use in the DAWN initiative (Conference Report 2004; International Diabetes Federation 2004; Peyrot et al 2005b, 2013; Skovlund and Peyrot 2005; Wroe 2006)
Recruitment Overall, 32 centers extracted by the electronic clinical record system information on 78,854 patients with type 2 diabetes for benchmarking activities based on clinical indicators, while 26 centers enrolled 2,390 patients for the validation and evaluation of patient centered outcomes
Summary
The prevention of diabetes and control of its micro- and macrovascular complications has become one of the main public health challenges for the 21st century, with the aim of attaining a significant reduction in the huge premature morbidity and mortality it causes, with a parallel reduction in health care costs (Shaw et al 2010) To this purpose, in addition to the implementation of strategies for diabetes prevention through lifestyle modification, a. Quality measures identified include process and intermediate outcome indicators, selected under the assumption that they are linked to downstream health outcomes These measures have been widely utilized to monitor quality of care and promote continuous quality improvement initiatives (Saaddine et al 2002, 2006). In Italy, the Associazione Medici Diabetologi (AMD) has implemented a continuous improvement effort involving over 300 diabetes clinics throughout the Country (Rossi et al 2008) To this purpose, AMD identified a set of quality indicators, including process and intermediate outcome measures. In the context of the DAWN-2 initiatives, the BENCH-D Study aims to test a model of regional benchmarking to improve the quality of diabetes care, and patient-centred outcomes
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