Quality Of Diabetes Care Research Articles

The Diabetes Team Dynamics Unraveled: A Qualitative Study

Background: Diabetes is a complex disease requiring a multidisciplinary approach. However, the dynamics of this collaboration and the involvement of healthcare providers remain unclear. Aim(s): To explore the composition, the division of roles/tasks, and the collaboration in a diabetes team. Methods: A qualitative, explorative study with six focus groups was conducted, of which four focus groups were with healthcare providers (n = 34) and two with informal caregivers and persons with diabetes (n = 13). In addition, two in-depth interviews with doctors were performed. An iterative process of data analysis took place, guided by the Qualitative Analysis Guide of Leuven (QUAGOL). Results: All participants confirm the importance of patient empowerment and the fact that the person with diabetes should have a central role within the team. However, this has not been achieved yet. This research gives a clear insight into the dynamics of a diabetes team. Roles and tasks are allocated according to the specific expertise and knowledge of the different healthcare providers. Interprofessional collaboration is the ultimate goal. However, the diabetes team is often formed ad hoc depending on the needs of the person with diabetes and the preferences for collaboration of the healthcare providers. Furthermore, this study revealed some important bottlenecks with regard to the knowledge of healthcare providers, persons with diabetes and their informal caregivers, the regulation and reimbursement. Discussion: Our study uncovers the dynamics of a diabetes team and its members. Healthcare providers work mainly alone, except in hospitals, where they can consult other healthcare providers briefly if necessary. Although collaboration proves to be difficult, all healthcare providers ask for a more intensive interprofessional collaboration. Conclusion: In order to improve quality of diabetes care, patient-centered care and the satisfaction of patients, informal caregivers, and healthcare providers, efforts have to be made to facilitate interprofessional collaboration. This can be achieved by sharing information via electronic shared patient records, coordination, overview, local task agreements, simplified legal regulations, and an adjusted financing system.

Diabetes care quality: do large medical groups perform better?

To compare primary care management processes (CMPs) and outcome measures for diabetes quality among large, medium, and small medical groups. Observational comparison of differences in processes and outcomes over time among 329 primary care practices that agreed to participate and returned completed surveys in both 2017 and 2019. We used a standardized composite measure of diabetes quality along with its 5 components and a survey measure of the presence of systematic CMPs to compare the outcomes and processes of care among clinics that were in large (≥ 12 sites), medium (4-11 sites), and small (1-3 sites) medical groups. Practices from large groups had better performance than those in medium and small groups on the composite measure of diabetes outcomes in 2017 (46.5 vs 40.6 and 34.4, respectively; P < .001), as well as on each of the 5 component measures. They also had more CMPs in place (74.2% vs 66.9% and 61.4%; P < .001), including the 10 CMPs that are associated with the highest level of performance (84.2% vs 77.9% and 72.2%; P < .001). However, repeated measures in 2019 showed that the smaller groups had gained on both quality and CMP measures. There was also substantial overlap on both CMPs and performance among practices in groups of different sizes. On average, primary care practices that are part of large well-established medical groups outperformed smaller-sized groups in diabetes care quality, probably because they have the resources, leadership, and infrastructure to provide more consistent care through more organized CMPs.

Defining Minimum Necessary Communication During Care Transitions for Patients on Antihyperglycemic Medication: Consensus of the Care Transitions Task Force of the IPRO Hypoglycemia Coalition.

IntroductionAntihyperglycemic agents are significant contributors to adverse drug events, responsible for emergency department visits, hospitalizations, and death. Nationally, the rate of serious hypoglycemic events associated with these agents remains high despite widespread efforts to improve drug safety. Transitions of care between healthcare settings can lead to communication challenges between care professionals and increase the risk of adverse drug events. System-based improvements are needed to assure the safe transitions for patients with diabetes who are on antihyperglycemic agents. The objective of this study was to develop a consensus list of requisite elements that should be communicated between care settings during transitions of patients who are prescribed antihyperglycemic agents.MethodsThe Island Peer Review Organization (IPRO) Hypoglycemia Coalition identified suboptimal transitions of care as a barrier to improving patient safety and quality of diabetes care. The Coalition formed a multidisciplinary Task Force with experts in the field of diabetes care. The Task Force created a draft list of requisite communication elements through literature review and deliberation on monthly conference calls. A blinded iterative Delphi process was subsequently performed to generate a consensus list of requisite communication elements that participating experts agreed were necessary to safely and effectively assume the management of patients with diabetes upon care transitions.ResultsThe Task Force completed a series of four iterative polls from September 2015 to August 2016, resulting in a final list of 22 requisite communication elements (the Diabetes Management Discharge Communication List), with the elements conceptually categorized into three domains: diagnosis and treatment, factors affecting glycemic control or patient risk, and patient self-management.ConclusionsThe Diabetes Management Discharge Communication List provides an initial framework for the development of diabetes-specific resources to improve clinical communication between care settings.

Quality and Implementation of Diabetic Care at a Free Clinic.

INTRODUCTIONAlthough typically receiving little government funding, free clinics help ensure access to affordable quality health care to the medically underserved. Established in 2004, the authors’ metropolitan Detroit Health Unit on Davison Avenue (HUDA) Clinic delivers primary care and specialized services to uninsured populations. The authors compared proportionate changes in A1c levels compared to prior national averages to evaluate the significance of care a free diabetes clinic can provide to uninsured populations.METHODSRetrospective data from 2017-2019 were reviewed of adult patients who have been diagnosed with Type 2 Diabetes. From HUDA Clinic medical records, data were collected concerning patient demographics, insurance status, pregnancy, major comorbidities and several factors related to diabetes standards of care.RESULTSThere were a total of 2,231 patient visits to HUDA Clinic in 2019, of which 125 patients (5.6%) received care for their Type 2 diabetes. Forty (32%) clinic patients who had a visit in 2019 had an HbA1c <7.0 and 29 (23%) had an HbA1c > 9.5. This is comparable to the 2020 National Diabetes Statistics Report in which approximately 50% (n = 15.6 million) of Americans had an HbA1c < 7.0 and 14% (n = 5.1 million) had an HbA1c > 9.5.CONCLUSIONSHuda Clinic’s diabetes care percentages were quite comparable to state and national data and CDC parameters, although these comparative results need to be considered in terms of the authors’ smaller sample size. These overall results indicate that health care providers can meet major recommended diabetic care at inner-city free clinics in metropolitan communities. Future provider and patient study studies regarding free clinic care patterns are clearly required to identify gaps in healthcare access and formulate and test specific strategies to improve diabetes-related outcomes.

Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study

Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80–2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89–2.60) and uncontrolled (AHR 2.28, 95% CI 1.80–2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78–8.05) and mental (AHR 3.97, 95% CI 2.29–6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.

The Impact of Telemedicine on Quality of Care for Patients with Diabetes After March 2020

BackgroundThe impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care.ObjectiveTo evaluate whether utilizing telemedicine in the first 9 months of the COVID-19 pandemic impacted performance on a diabetes quality of care measure for patients at a large academic medical center. We hypothesized care quality would reduce less among telemedicine users.DesignQuasi-experimental design using binomial logistic regression. Covariates included age, gender, race, ethnicity, type of insurance, hierarchical condition category score, primary language at the individual level, and zip code–level income.ParticipantsAll adult patients younger than 75 years of age diagnosed with type 2 diabetes mellitus (N = 16,588) as of 3/19/2020 at a single academic health center.InterventionsCompletion of one or more telemedicine encounters with an institutional primary care physician or endocrinologist between 3/19/2020 and 12/19/2020.Main MeasuresThe components met in a five-item composite measure of diabetes quality of care, as of patients’ last clinical encounter. Items were (1) systolic blood pressure less than 140 mmHg, (2) hemoglobin A1c less than 8.0%, (3) using a statin and (4) aspirin, and (5) tobacco non-use.Key ResultsFrom the pre- to post-period, the probability of meeting any given component of the composite measure for patients only utilizing in-person care was 21% lower (OR, 95% CI 0.79; 0.76, 0.81) and for the telemedicine users 2% lower (OR 0.98; 0.85, 1.13). There was an increased likelihood of meeting any given component among telemedicine users compared to in-person care alone (OR 1.25; 1.08, 1.44).ConclusionsPatients with diabetes utilizing telemedicine performed similarly on a composite measure of diabetes care quality compared to before the pandemic. Those not utilizing telemedicine had reductions. Telemedicine use maintained quality of care for patients with diabetes during the first 9 months of the COVID-19 pandemic.

The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data

BackgroundMultimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA.MethodsWe conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD.ResultsAmong 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one’s own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one’s home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA.ConclusionsThe quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

Need for improved diabetes support among people with psychiatric disorders and diabetes treated in psychiatric outpatient clinics: results from a Danish cross-sectional study

IntroductionPeople with psychiatric disorders have increased risk of premature death partly due to diabetes. This study aims to explore the quality of diabetes care, diabetes management, diabetes support and well-being...

Developing Clinical Decision Support System using Machine Learning Methods for Type 2 Diabetes Drug Management.

Background and Objectives:Application of artificial intelligence/machine learning (AI/ML) for automation of diabetes management can enhance equitable access to care and ensure delivery of minimum standards of care. Objective of the current study was to create a clinical decision support system using machine learning approach for diabetes drug management in people living with Type 2 diabetes.Methodology:Study was conducted at an Endocrinology clinic and data collected from the electronic clinic management system. 15485 diabetes prescriptions of 4974 patients were accessed. A data subset of 1671 diabetes prescriptions of 940 patients with information on diabetes drugs, demographics (age, gender, body mass index), biochemical parameters (HbA1c, fasting blood glucose, creatinine) and patient clinical parameters (diabetes duration, compliance to diet/exercise/medications, hypoglycemia, contraindication to any drug, summary of patient self monitoring of blood glucose data, diabetes complications) was used in analysis. An input of patient variables were used to predict all diabetes drug classes to be prescribed. Random forest algorithms were used to create decision trees for all diabetes drugs.Results and Conclusion:Accuracy for predicting use of each individual drug class varied from 85% to 99.4%. Multi-drug accuracy, indicating that all drug predictions in a prescription are correct, stands at 72%. Multi drug class accuracy in clinical application may be higher than this result, as in a lot of clinical scenarios, two or more diabetes drugs may be used interchangeably. This report presents a first positive step in developing a robust clinical decision support system to transform access and quality of diabetes care.

Is Sociodemographic Status Associated with Empathic Communication and Decision Quality in Diabetes Care?

ObjectiveTo assess the relationship between empathic communication, shared decision-making, and patient sociodemographic factors of income, education, and ethnicity in patients with diabetes.Research Design and MethodsThis was a cross-sectional study from five primary care practices in the Greater Toronto Area, Ontario, Canada, participating in a randomized controlled trial of a diabetes goal setting and shared decision-making plan. Participants included 30 patients with diabetes and 23 clinicians (physicians, nurses, dietitians, and pharmacists), with a sample size of 48 clinical encounters. Clinical encounter audiotapes were coded using the Empathic Communication Coding System (ECCS) and Decision Support Analysis Tool (DSAT-10).ResultsThe most frequent empathic responses among encounters were “acknowledgement with pursuit” (28.9%) and “confirmation” (30.0%). The most frequently assessed DSAT components were “stage” (86%) and knowledge of options (82.0%). ECCS varied by education (p=0.030) and ethnicity (p=0.03), but not income. Patients with only a college degree received more empathic communication than patients with bachelor’s degrees or more, and South Asian patients received less empathic communication than Asian patients. DSAT varied with ethnicity (p=0.07) but not education or income. White patients experienced more shared decision-making than those in the “other” category.ConclusionsWe identified a new relationship between ECCS, education and ethnicity, as well as DSAT and ethnicity. Limitations include sample size, heterogeneity of encounters, and predominant white ethnicity. These associations may be evidence of systemic biases in healthcare, with hidden roots in medical education.

Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices

Diabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care. To examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care. This cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020. The primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty. Among the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas. This cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.

Quality of diabetes care and its consequences in Northern Iran

Background. Diabetes is an important public health problem. This study aimed to investigate the quality of care in patients with diabetes type 2 and its consequences in rural areas at Golestan province, North of Iran, in comparison to standards of the Ministry of Health and Education of Iran and the American Diabetes Association. Methods. This was a cross-sectional study based on data from 308 patients with diabetes type 2 in rural areas at Golestan province, which was conducted through a two-stage classified sampling method and random selection. Data of this research was gathered through a questionnaire (fulfilled by the interviewer), assessment blood sugar, and information obtained from patients’ files. Data were analyzed by descriptive statistics and SPSS version19. Results. The mean age of patients was 57 years and 88 patients (29%) were male. Only 35% of patients were visited seasonally by a family physician. In addition, only 24% of patients were visited at least once a year by an ophthalmologist, and 31% of patients underwent a glycated hemoglobin test at least twice a year. Influenza and hepatitis vaccines were given to 1.6% and 9.4% of patients, respectively. 85% of patients were evaluated once a year for lipid profile and 61% for creatine and albumin. Only 31% of patients received nutrition counseling at least once a year. Controlled glycated hemoglobin (HBA1c) was 27% and most patients were in the range of overweight and obesity (&gt; 75%). Conclusion. The findings of this study showed that the quality of diabetes care and its consequences in patients is not desirable and is far from the standards provided by the Iran’s Ministry of Health and the American Diabetes Association and requires revision in the current program of diabetes control.

Data Resource Profile: The Hong Kong Diabetes Surveillance Database (HKDSD).

Diabetes has become one of the most challenging health problems, which affects around 1 in 10 adults worldwide.1,2 The last three decades have witnessed a significant change in the global epidemiological patterns of diabetes.3,4 However, the existing large epidemiological studies are mainly from North America and Europe. Population-based representative data are lacking in Asia,3–5 where 60% of the world’s population with diabetes are living.2 Asians have a different diabetes phenotype compared with White European ancestry, with different countries in Asia undergoing epidemiological transition at various stages.6 Large diabetes databases, such as population-based diabetes registries and those generated from a national electronic medical record (EMR), are important data sources for diabetes epidemiological research. These resources are representative of the study population with findings that are generalizable.7 The Hong Kong Diabetes Surveillance Database (HKDSD) includes all people who have ever had a measurement of blood glucose since 2000 in the public healthcare sector in Hong Kong. The HKDSD was established with the major aims of: (i) integrating EMR data for surveillance of gestational diabetes (GDM), prediabetes, diabetes and diabetes-related complications in Hong Kong; (ii) evaluating the quality of care for diabetes, exploring and quantifying the effect of clinical factors and interventions on health outcomes of diabetes; (iii) identifying priorities for prevention and treatment of diabetes, and curating evidence to inform clinical practice and policy-making.

Аналіз індикаторів якості діабетологічної допомоги в країнах світу та шляхи оптимізації оцінки й моніторингу якості діабетологічної допомоги в Україні

Контроль і моніторинг якості медичної допомоги — стратегічна мета охорони здоров’я кожної країни. Мета дослідження — проаналізувати індикатори якості діабетологічної допомоги в різних країнах світу та можливість їх імплементації в систему охорони здоров’я України для оптимізації оцінки й моніторингу якості діабетологічної допомоги. Матеріали та методи: здійснено інформаційний пошук за ключовими словами quality indicators, diabetes care, primary care, secondary care, guidelines у мережі Інтернет за 2000–2014 рр., відібрано для аналізу 60 джерел, що найбільше відповідають поставленій меті. Крім того, проведено опитування представників 19 країн Європи, присутніх на засіданні Vasko da Gama Europe Council Meeting, щодо різних аспектів діабетологічної допомоги, оцінки національних керівництв та індикаторів якості за англомовною анкетою. Для обробки даних застосовували статистичні методи, програми Exсel 2007, SPSS. Результати. У більшості країн світу аналіз якості діабетологічної допомоги здійснюється переважно за допомогою клінічних індикаторів (процесу та результату). У деяких країнах індикатори не використовуються, а там, де вони рекомендовані, їх кількість може сягати 38. У деяких країнах індикатори мають певні цільові межі, яких необхідно досягти в процесі надання діабетологічної допомоги. З урахуванням проведеного аналізу нормативної бази в Україні пропонується збільшення кількості існуючих (основних) індикаторів якості діабетологічної допомоги за рахунок запропонованих додаткових індикаторів. Висновок. Запровадження в Україні розширеного переліку індикаторів якості діабетологічної допомоги, що розкривають структуру, процес та результат якості медичної допомоги, сприятиме більш детальному аналізу всіх аспектів якості діабетологічної допомоги, дозволить виявити її недоліки, сприятиме покращанню ефективності медичної допомоги загалом, її оцінки і моніторингу.

Аналіз змін якості діабетологічної допомоги за умов впровадження уніфікованого клінічного протоколу з надання медичної допомоги хворим на цукровий діабет 2-го типу

У зв’язку з затвердженням уніфікованого клінічного протоколу з ведення цукрового діабету (ЦД) 2-го типу в 2012 році актуальною є оцінка результатів його впровадження та якості медичної допомоги при ЦД. Мета — провести аналіз якості медичної допомоги за 2003–2012–2014 рр. та результатів впровадження уніфікованого клінічного протоколу з надання медичної допомоги хворим на ЦД 2-го типу (наказ МОЗ України № 1118 від 21 грудня 2012 р.) в Україні та Київській області. Матеріали та методи. Нами було розроблено методику, що включає моніторинг індикаторів якості, аналіз даних статистичних звітів медичних закладів, які доповнювалися анкетуванням 543 лікарів і 92 пацієнтів із ЦД 2-го типу та аналізом їх амбулаторних карток. Результати. Якість діабетологічної допомоги на ранніх стадіях впровадження є недостатньою. Рекомендований щорічний моніторинг здійснюється не в повному обсязі, не всіх рекомендованих показників і не в усіх хворих, до того ж у недостатньому обсязі виконуються профілактичні заходи, і в результаті не всі пацієнти досягають цільових рівнів показників. Це призвело до підвищення рівня госпіталізації з приводу ЦД та зменшення первинної захворюваності, що є результатом не тільки недостатньої прихильності лікарів, але й недостатньої прихильності пацієнтів до лікування та впливу соціально-економічних аспектів життя в сучасній Україні. Отримані нами результати подібні до європейських результатів щодо впровадження нових керівництв із ведення цукрового діабету. У зв’язку з наростанням поширеності і захворюваності на ЦД 2-го типу продовжується збільшення навантаження на лікарів-ендокринологів. Із метою оптимізації якості медичної допомоги хворим на ЦД 2-го типу необхідні забезпечення доступності лабораторних досліджень та більш активне залучення лікарів первинної ланки, для чого нами розроблено та запроваджено типовий локальний протокол, форму моніторингу якості діабетологічної допомоги пацієнту, проводяться додаткові освітні заходи (лекції, семінари, тренінги, цикли тематичного удосконалення) для лікарів, медсестер та хворих. Висновки. Якість діабетологічної допомоги на ранній стадії є недостатньою. Запроваджені заходи оптимізації якості діабетологічної допомоги в Київській області дали позитивні результати.

Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study.

BackgroundImprovements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes.ObjectiveThis study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care.MethodsOverall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses.ResultsPeople with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit.ConclusionsThe Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark.

Patient Perspectives on Virtual Care for Diabetes Management in the Era of COVID-19

The aim of this study was to characterize patient perspectives on the quality of diabetes care at The Ottawa Hospital Endocrinology and Metabolism multidisciplinary clinic delivered virtually during the COVID-19 pandemic.

Barriers and Diabetes Care Quality in Public Schools in the United States

Objective: In this study, we examined the influence of multi-level barriers on school diabetes care quality. Methods: We administered an online survey to nurses in Missouri K-12 schools (N = 245). We assessed 57 potential barriers in 5 domains (at individual, school, community, social/ cultural, and political/economic levels). We developed 38 criteria for care quality based on the National Institute of Diabetes and Digestive and Kidney Diseases’ school diabetes care guidelines. We carried out structural equation modeling to examine the effect of barriers on school diabetes care quality. Results: School nurses’ heavy workloads, teachers’/parents’ lack of training/knowledge on evidence-based practices, and lack of funding from government, districts, and schools serving disadvantaged or rural populations were among the key barriers to school diabetes care. Deficiencies in care quality were identified in areas including knowledge/training, communication, school policies, resources and environment, physical activity engagement among students with diabetes, school nurses’ diabetes management practices, and trained diabetes practitioners’ responsibilities. School diabetes care barriers, overall, were inversely associated with care quality; one standard deviation increase in the barriers was associated with a 0.163 (95% confidence interval = 0.002- 0.324) standard-deviation decrease in care quality. Conclusions: Multi-level policy interventions are called upon to address these barriers to improve care quality and ensure the healthy growth of students with diabetes.

Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe.

Registries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe. We aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research. Survey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017. The 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years. The heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes.

Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care.

ABSTRACT &#x0D; Introduction: The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus.&#x0D; Materials and Methods: This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (&gt; 80%) were considered satisfied.&#x0D; Results: A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97; p = 0.008)&#x0D; Conclusion: 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction&#x0D;