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Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?

Van Casteren VF, Bossuyt NH, Moreels SJ, Goderis G, Vanthomme K, Wens J, De Clercq EW - Arch Public Health (2015)

Bottom Line: Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients.However, results on outcome parameters remain inconclusive.

View Article: PubMed Central - PubMed

Affiliation: Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium.

ABSTRACT

Background: The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care.

Methods: This observational study took place in the period 2006-2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.

Results: By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion.

Conclusions: According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.

No MeSH data available.


Related in: MedlinePlus

HbA1c levels in diabetes type 2 care trajectory (CT) patients by year of CT start, central pillar data 2008–2011. HbA1c levels in diabetes type 2 care trajectory (CT) patients after CT start, for the cohort of CT patients who started the CT in 2009, 2010 and 2011
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Fig3: HbA1c levels in diabetes type 2 care trajectory (CT) patients by year of CT start, central pillar data 2008–2011. HbA1c levels in diabetes type 2 care trajectory (CT) patients after CT start, for the cohort of CT patients who started the CT in 2009, 2010 and 2011

Mentions: The central pillar data showed a significant decrease, after CT start, in HbA1c among three cohorts of T2DM-CT patients, with CT start in 2009, 2010 and 2011, respectively (Fig. 3). This finding was confirmed by the Intego dataset [30]. According to the central pillar data, T2DM-CT patients also experienced a significant decrease in LDL cholesterol, blood pressure and BMI after CT start (data not shown). However, these findings were not confirmed by the Intego dataset.Fig. 3


Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?

Van Casteren VF, Bossuyt NH, Moreels SJ, Goderis G, Vanthomme K, Wens J, De Clercq EW - Arch Public Health (2015)

HbA1c levels in diabetes type 2 care trajectory (CT) patients by year of CT start, central pillar data 2008–2011. HbA1c levels in diabetes type 2 care trajectory (CT) patients after CT start, for the cohort of CT patients who started the CT in 2009, 2010 and 2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4499949&req=5

Fig3: HbA1c levels in diabetes type 2 care trajectory (CT) patients by year of CT start, central pillar data 2008–2011. HbA1c levels in diabetes type 2 care trajectory (CT) patients after CT start, for the cohort of CT patients who started the CT in 2009, 2010 and 2011
Mentions: The central pillar data showed a significant decrease, after CT start, in HbA1c among three cohorts of T2DM-CT patients, with CT start in 2009, 2010 and 2011, respectively (Fig. 3). This finding was confirmed by the Intego dataset [30]. According to the central pillar data, T2DM-CT patients also experienced a significant decrease in LDL cholesterol, blood pressure and BMI after CT start (data not shown). However, these findings were not confirmed by the Intego dataset.Fig. 3

Bottom Line: Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients.However, results on outcome parameters remain inconclusive.

View Article: PubMed Central - PubMed

Affiliation: Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium.

ABSTRACT

Background: The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care.

Methods: This observational study took place in the period 2006-2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.

Results: By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion.

Conclusions: According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.

No MeSH data available.


Related in: MedlinePlus