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Evidence summaries

Quality Improvement Strategies for Diabetes Care

Multicomponent quality improvement strategies like case management with team change and promotion of self management may improve diabetes care results. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412 161 participants. Many different stragies were used: case management, team changes, electronic patient registry, facilitated relay of clinical information, continuous quality improvement (system targeted); audit and feedback, clinician education, clinician reminders, financial incentives (provider targeted); patient education, promotion of self-management, patient reminders (patient-targeted). The effects of individual strategies were modest. Combining case management, team changes, patient education, and promotion of self-management gave the best results for lowering the HbA1c, and systolic blood pressure: with lower baseline of HbA1c under 8.3%, the absolute mean difference was -0.25 (-0.36 to -0.13) and with baseline HbA1c over 8.3% the mean difference was -0.67 (-0.82 to -0.53).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concelament, incomplete outcome data, selective reporting in half of the sudies).

    References

    • Konnyu KJ, Yogasingam S, Lépine J, ym. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023;5(5):CD014513 [PubMed]

Primary/Secondary Keywords