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Article: Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: a population-based retrospective cohort study after implementation of a quality improvement initiative
Title | Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: a population-based retrospective cohort study after implementation of a quality improvement initiative |
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Authors | |
Keywords | Database research Primary care Quality of care Temporal trend Type 2 diabetes |
Issue Date | 2018 |
Publisher | John Wiley & Sons Ltd. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1520-7560 |
Citation | Diabetes/Metabolism Research and Reviews, 2018, v. 34 n. 2, article no. e2952 How to Cite? |
Abstract | Background: This study examined whether temporal trends exist in treatment of patients with type 2 diabetes (T2D) and quality of diabetes care after implementation of quality improvement initiative in primary care setting. Methods: We conducted a population-based retrospective cohort study of 202,284 patients with T2D who were routinely managed in primary care clinics. We examined the change over time and the variability between clinics in quality-of-care from Hospital Authority administrative data over a five-year period (2009-2013), and used multilevel logistic regression to adjust for patient and clinic characteristics. Observational period was partitioned in five calendar years. Ten quality-of-care criteria were selected: adherence to seven process of care criteria (HbA1c test, renal function test, full lipid profile, urine protein analysis, retinal screening, lipid-lowering agent prescriptions among patients with hypercholesterolaemia, and ACEI/ARB prescriptions among patients with microalbuminuria) and three outcome of care criteria (HbA1c≤7%, BP≤130/80mmHg, LDL-C≤2.6mmol/L). Variability of standards between clinics was assessed using intra-cluster correlation coefficients. Results: Characteristics of Patients with T2D managed in primary care changed substantially during the observational period, with increasing age and usage of insulin, longer duration of diabetes but improved metabolic profiles (all P-trend<0.001). Performance rates of the seven process and three clinical outcome of care criteria increased remarkably over time (all P-trend<0.001). Variations in retinal screening delivery between clinics was considerable, albeit decreasing over time. Conclusions: Coinciding with implementation of quality improvement initiative, quality of diabetes care improved significantly in the past 5 years, in part attributable to benefits of integrated multidisciplinary diabetes management. |
Persistent Identifier | http://hdl.handle.net/10722/247490 |
ISSN | 2023 Impact Factor: 4.6 2023 SCImago Journal Rankings: 1.991 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Fung, SCC | - |
dc.contributor.author | Yu, YTE | - |
dc.contributor.author | Wan, YF | - |
dc.contributor.author | Chan, KC | - |
dc.contributor.author | Lam, CLK | - |
dc.date.accessioned | 2017-10-18T08:28:05Z | - |
dc.date.available | 2017-10-18T08:28:05Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | Diabetes/Metabolism Research and Reviews, 2018, v. 34 n. 2, article no. e2952 | - |
dc.identifier.issn | 1520-7560 | - |
dc.identifier.uri | http://hdl.handle.net/10722/247490 | - |
dc.description.abstract | Background: This study examined whether temporal trends exist in treatment of patients with type 2 diabetes (T2D) and quality of diabetes care after implementation of quality improvement initiative in primary care setting. Methods: We conducted a population-based retrospective cohort study of 202,284 patients with T2D who were routinely managed in primary care clinics. We examined the change over time and the variability between clinics in quality-of-care from Hospital Authority administrative data over a five-year period (2009-2013), and used multilevel logistic regression to adjust for patient and clinic characteristics. Observational period was partitioned in five calendar years. Ten quality-of-care criteria were selected: adherence to seven process of care criteria (HbA1c test, renal function test, full lipid profile, urine protein analysis, retinal screening, lipid-lowering agent prescriptions among patients with hypercholesterolaemia, and ACEI/ARB prescriptions among patients with microalbuminuria) and three outcome of care criteria (HbA1c≤7%, BP≤130/80mmHg, LDL-C≤2.6mmol/L). Variability of standards between clinics was assessed using intra-cluster correlation coefficients. Results: Characteristics of Patients with T2D managed in primary care changed substantially during the observational period, with increasing age and usage of insulin, longer duration of diabetes but improved metabolic profiles (all P-trend<0.001). Performance rates of the seven process and three clinical outcome of care criteria increased remarkably over time (all P-trend<0.001). Variations in retinal screening delivery between clinics was considerable, albeit decreasing over time. Conclusions: Coinciding with implementation of quality improvement initiative, quality of diabetes care improved significantly in the past 5 years, in part attributable to benefits of integrated multidisciplinary diabetes management. | - |
dc.language | eng | - |
dc.publisher | John Wiley & Sons Ltd. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1520-7560 | - |
dc.relation.ispartof | Diabetes/Metabolism Research and Reviews | - |
dc.rights | Diabetes/Metabolism Research and Reviews. Copyright © John Wiley & Sons Ltd. | - |
dc.rights | This is the peer reviewed version of the following article: Diabetes/Metabolism Research and Reviews, 2018, v. 34 n. 2, e2952, which has been published in final form at https://doi.org/10.1002/dmrr.2952. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. | - |
dc.subject | Database research | - |
dc.subject | Primary care | - |
dc.subject | Quality of care | - |
dc.subject | Temporal trend | - |
dc.subject | Type 2 diabetes | - |
dc.title | Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: a population-based retrospective cohort study after implementation of a quality improvement initiative | - |
dc.type | Article | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Fung, SCC: cfsc@hku.hk | - |
dc.identifier.email | Yu, YTE: ytyu@hku.hk | - |
dc.identifier.email | Wan, YF: yfwan@hku.hk | - |
dc.identifier.email | Chan, KC: kcchanae@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Fung, SCC=rp01330 | - |
dc.identifier.authority | Yu, YTE=rp01693 | - |
dc.identifier.authority | Wan, YF=rp02518 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1002/dmrr.2952 | - |
dc.identifier.pmid | 28925010 | - |
dc.identifier.scopus | eid_2-s2.0-85031682190 | - |
dc.identifier.hkuros | 279980 | - |
dc.identifier.volume | 34 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | article no. e2952 | - |
dc.identifier.epage | article no. e2952 | - |
dc.identifier.isi | WOS:000425143500001 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 1520-7552 | - |