Optimisation of quality indicators for lipid-lowering treatment of type 2 diabetes mellitus.

INTRODUCTION: The Danish Adult Diabetes Database (DADD) annually reports a quality indicator for lipid-lowering treatment of type 2 diabetes mellitus (T2DM) patients. This retrospective cohort study aims to A) investigate the reasons for inadequate or lacking lipid-lowering treatment and to B) assess the validity of the DADD indicator as a measure of quality of care. METHODS: A) A pop-up questionnaire enquiring about reasons for lack of treatment was added to the clinicians' data entry tool in the Central Denmark Region. B) The DADD indicator was compared on a per-clinic basis with the achieved median low-density lipoprotein (LDL) cholesterol level and with an internationally widely used indicator of lipid-lowering treatment quality. RESULTS: A) A total of 3,491 patients were registered from 1 January 2013 to 28 February 2015. For 170 (62%) of 309 patients with an LDL level > 2.5 mmol/l who were not receiving lipid-lowering treatment, there was no "good" explanation for lacking treatment. Among 518 patients with an LDL level > 2.5 mmol/l despite lipid-lowering treatment, 259 (50%) did not receive high-intensity treatment. B) The DADD quality indicator was neither associated with the international quality indicator nor with the median per-clinic LDL level for T2DM patients. CONCLUSIONS: A) We found substantial potential for improvement of lipid management among T2DM patients in Denmark by initiating and/or intensifying lipid-lowering treatment. B) The current DADD indicator is not a valid measure of lipid-lowering quality of care. FUNDING: supported by the Rosa and Asta Jensen Foundation. TRIAL REGISTRATION: not relevant.

The Aarhus Neuromodulation Database.

OBJECTIVES: €‚ Spinal cord stimulation (SCS) is increasingly gaining widespread use as a treatment for chronic pain. A widely used electronic registry could play a pivotal role in improving this complex and cost-€intensive treatment. We aimed to construct a comprehensive, universally available data base for SCS. MATERIALS AND METHODS: €‚ The design considerations behind a new online data base for SCS are presented; basic structure, technical issues, research applications, and future perspectives are described. RESULTS: €‚ The Aarhus Neuromodulation Database covers core SCS treatment parameters, including procedure-€related details and complications, and features recording of key success parameters such as pain intensity, work status, and quality of life. It combines easy access to patient information with exhaustive data extraction options, and it can readily be adapted and expanded to suit different needs, including other neuromodulation treatment modalities. CONCLUSIONS: €‚ We believe that the data base described in this article offers a powerful and versatile data collection tool suited for both clinicians and researchers in the field. The basic data base structure is immediately available on a no€-cost basis, and we invite our colleagues to make use of the data base as part of the efforts to further the field of neuromodulation.