Randomized trial of quality improvement intervention to improve diabetes care in primary care settings.

OBJECTIVE: To assess the impact of a quality improvement (QI) intervention on the quality of diabetes care at primary care clinics. RESEARCH DESIGN AND METHODS: Twelve primary care medical practices were matched by size and location and randomized to intervention or control conditions. Intervention clinic staff were trained in a seven-step QI change process to improve diabetes care. Surveys and medical record reviews of 754 patients, surveys of 329 clinic staff, interviews with clinic leaders, and analysis of training session videotapes evaluated compliance with and impact of the intervention. Mixed-model nested analyses compared differences in the quality of diabetes care before and after intervention. RESULTS: All intervention clinics completed at least six steps of the seven-step QI change process in an 18-month period and, compared with control clinics, had broader staff participation in QI activities (P = 0.04), used patient registries more often (P = 0.03), and had better test rates for HbA(1c) (A1C), LDL, and blood pressure (P = 0.02). Other processes of diabetes care were unchanged. The intervention did not improve A1C (P = 0.54), LDL (P = 0.46), or blood pressure (P = 0.69) levels or a composite of these outcomes (P = 0.35). CONCLUSIONS: This QI change process was successfully implemented but failed to improve A1C, LDL, or blood pressure levels. Data suggest that to be successful, such a QI change process should direct more attention to specific clinical actions, such as drug intensification and patient activation.

Improving diabetes care and outcomes: the secondary benefits of a public health-managed care research collaboration.

The project improving Diabetes Care through Empowerment, Active Collaboration and Leadership (IDEAL) is a collaborative translational research project of the Minnesota Diabetes Program (MDP) at the Minnesota Department of Health and HealthPartners (HP), a large managed care organization. The research was designed to test a quality improvement model to improve diabetes care delivery and outcomes in primary care clinics, but the collaboration was structured from the beginning to maximize potential secondary effects. The MDP and HP participated jointly in every aspect of the project. Personnel from other health care systems and academic and quality improvement organizations also participated in IDEAL. Secondary effects included heightened priority for diabetes care improvement at HP and within its medical group, along with an increased emphasis on a population approach for both of these organizations. Simultaneously, the MDP developed a better understanding of the issues and potential for improving care in primary care clinics, medical groups, and managed care organizations. These benefits resulted in further collaboration between the MDP, HP, and other managed care, health care, and quality improvement organizations in Minnesota. Thus, Project IDEAL has been a successful collaboration of public health and managed care whose contribution to improved diabetes care in Minnesota health systems extends far beyond the original scope of the project.