Outcomes Measurement Design for a Performance Improvement Initiative in Diabetes Care
Background: Despite wide acceptance of diabetes treatment guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE), optimal management of patients with type 2 diabetes remains a challenge. Improved patient outcomes, including reduced mortality and associated micro- and macrovascular complications, have been associated with adherence to guideline recommendations. This article describes a performance improvement (PI) initiative designed to improve physician practice behavior and patient outcomes by addressing gaps in process-related diabetes care. PI is an American Medical Association (AMA)-approved, standardized continuing medical education (CME) format in which practitioners, including physicians, nurse practitioners, and physician assistants, can earn up to 20 AMA PRA Category 1 Credits. In the first stage, participants complete a self-assessment review to identify areas in which patient care can be improved. In the second stage, participants develop and implement a PI plan that addresses these identified areas of care. In the third stage, participants complete a second self-assessment review to determine the impact of their improvement strategies.
Methods: In this diabetes PI initiative, participants will assess their practice by means of performance measures defined by the 2007 AACE and 2008 ADA guidelines within 3 general benchmark areas: (1) lifestyle-modification recommendations (specifically related to discussion on exercise), (2) prevention of microvascular complications (focus on overall foot care), and (3) monitoring of glycemic control (by measuring hemoglobin A1c at recommended intervals and taking action based on the results). After completing a self-assessment and identifying 1 or more areas of improvement, participants will be able to complete educational interventions and to access specific tools that provide guidance on improving adherence to the ADA/AACE guidelines.
Results: The results and analysis of this program will be presented in a subsequent publication. This PI initiative supplements other ongoing quality-improvement initiatives in diabetes in that it uses individual practitioner self-assessment, benchmark-focused CME, and self-developed PI plans to improve process-related diabetes care.
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