TY - JOUR
T1 - Effectiveness of a multicomponent quality improvement strategy to improve achievement of diabetes care goals a randomized, controlled trial
AU - Ali, Mohammed K.
AU - Singh, Kavita
AU - Kondal, Dimple
AU - Devarajan, Raji
AU - Patel, Shivani A.
AU - Shivashankar, Roopa
AU - Ajay, Vamadevan S.
AU - Unnikrishnan, A. G.
AU - Usha Menon, V.
AU - Varthakavi, Premlata K.
AU - Viswanathan, Vijay
AU - Dharmalingam, Mala
AU - Bantwal, Ganapati
AU - Sahay, Rakesh Kumar
AU - Masood, Muhammad Qamar
AU - Khadgawat, Rajesh
AU - Desai, Ankush
AU - Sethi, Bipin
AU - Prabhakaran, Dorairaj
AU - Venkat Narayan, K. M.
AU - Tandon, Nikhil
N1 - Publisher Copyright:
© 2016 American College of Physicians.
PY - 2016/9/20
Y1 - 2016/9/20
N2 - Background: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia. Objective: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes. Design: Parallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328) Setting: Diabetes clinics in India and Pakistan. Patients: 1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL). Intervention: Multicomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records. Measurements: Proportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, healthrelated quality of life (HRQL), and treatment satisfaction (secondary outcomes). Results: Baseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7mmHg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction. Limitation: Findings were confined to urban specialist diabetes clinics. Conclusion: Multicomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics. Primary Funding Source: National Heart, Lung, and Blood Institute and UnitedHealth Group.
AB - Background: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia. Objective: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes. Design: Parallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328) Setting: Diabetes clinics in India and Pakistan. Patients: 1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL). Intervention: Multicomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records. Measurements: Proportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, healthrelated quality of life (HRQL), and treatment satisfaction (secondary outcomes). Results: Baseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7mmHg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction. Limitation: Findings were confined to urban specialist diabetes clinics. Conclusion: Multicomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics. Primary Funding Source: National Heart, Lung, and Blood Institute and UnitedHealth Group.
UR - https://www.scopus.com/pages/publications/84988462522
U2 - 10.7326/M15-2807
DO - 10.7326/M15-2807
M3 - Article
C2 - 27398874
AN - SCOPUS:84988462522
SN - 0003-4819
VL - 165
SP - 399
EP - 408
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 6
ER -
