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Making Systems Changes for Better Diabetes CareMaking Systems Changes for Better Diabetes Care

Topic last updated Jan. 2006
In This Section
» Commitment and Incentives
» Identify Gaps
»  Establish Goals for Improvement
» Models for Chronic Care Improvement
 
- Chronic Care Model
- PDSA Cycle
- Enhanced Primary Care Model
» Assessment and Accountability
» Changes at Various Levels 
» Successful Quality Improvement Projects
» Resources

Remember

Benchmarking can improve productivity by:

Identifying a problem:

- selecting the external benchmark
- gathering internal data
- identifying variances
- establishing targets

Taking action:

- determining actions
- defining responsibilities
- implementing the changes
- monitoring performance

How to Make Systems Changes
for Improved Care

Assessment and Accountability

Medical record audit and feedback, in which clinicians receive reports of their performance and often a comparison to the mean performance of their peers, is frequently used as a quality improvement methods. Although based on the theory that comparison to peers would be a powerful motivator for change, this method has had only small to moderate effects on improving health outcomes. 13

A recent advance to increase the effectiveness of performance feedback is the achievable benchmark method, calculated for a specific indicator of care such as the percentage of patients with diabetes receiving an A1C test twice a year.14 15 It represents the average performance for the top 10 percent of clinicians being assessed in a peer group. Group practices can use benchmarking to improve physician productivity to best-practice levels by first identifying a problem, then taking action.16

In a randomized, controlled trial, the use of benchmarks enhanced the effectiveness of physician performance feedback and led to a significantly greater proportion of patients receiving evidenced-based diabetes care.14 Achievable benchmarks of care are easily calculated from existing performance data.

Comparison of random medical record reviews in over 75 percent of Indian Health Service and tribal facilities have been compared for 1995, 1996, and 1997 as part of a diabetes care and outcomes audit using Diabetes Quality Improvement Project (DQIP) measures as benchmarks. Results showed that almost all DQIP measures improved over the three-year period.17 For more information on DQIP click here (or see resources).

Feedback systems can be enhanced by the addition of items on which the provider may take direct action. In addition to reporting provider performance (the percentage of patients that have not had an A1C in the last six months) the provider is given the names of patients who failed to meet the goal. Armed with this information, providers can take concrete steps to improve their performance.  For example, the list of patients may be contacted by office staff to schedule the necessary services.


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How: Changes at Various Levels

 

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