Abstract
BackgroundEvidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland.MethodsThe data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups.ResultsThe proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p.ConclusionsThe achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.
Highlights
Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care
Age-adjusted changes in process and outcome indicators The overall age-adjusted change in the proportion of patients who achieved the treatment target was not much different from the non-adjusted results: 5.7%p decrease for Glycated hemoglobin (HbA1c) and 5.6%p increase for Lowdensity lipoproteins (LDL)
In contrast to the overall picture, the difference between sexes became more obvious after. In this Electronic health records (EHR)-based study, the processes and outcomes of care were evaluated among all type 2 diabetic patients who were living in the North Karelia during the fiveyear follow-up period
Summary
Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland. Complications associated with type 2 diabetes can be prevented, or at least postponed, by the good care of diabetes [3]. Evidence-based guidelines have been published internationally and nationally to support the treatment and care decision-making among healthcare professionals [4,5,6,7]. According to the guidelines of American Diabetes Association [6] and Finnish Current Care Guidelines [5], lifestyle management, including changes in diet and physical activity, weight management and smoking cessation, combined with suitable pharmacological treatment are the cornerstones of diabetes care
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