Monitoring Modifiable Cardiovascular Risk in Type 2 Diabetes Care in General Practice

BACKGROUND: Because many patients in usual care reach the diabetes treatment goals, it may be more efficacious to focus quality improvement efforts on those general practice populations requiring additional support. We therefore developed a tool based on a composite end point considering blood pressure, lipids, and glycaemia. METHODS: We created an aggregated z(A)-score, calculated as the average of 3 z-scores testing whether the mean practice values of hemoglobin A1c, low density lipoprotein cholesterol, and systolic blood pressure are significantly higher than the corresponding ADA-target (respectively 7%, 100 mg/dL, and 130 mm Hg). This score was used with 100 general practitioners who participated in a Quality Improvement Program. We defined the cut-off value (COV) to determine "Practices Requiring Support" (z(A) <COV) using a receiver's operating characteristics curve with the mean practice CHD risk as gold standard. To further test the z-score validity, we calculated the correlation coefficient between the z-score and the mean practice CHD risk and the improvement in the z-score after the Quality Improvement Program. RESULTS: The COV was -1.22 and was valid to discriminate between practices at higher risk from practices at lower CHD risk (24% +/- 4% vs. 19% +/- 4%). The correlation coefficient was -0.515 (P = 0.001). The average z-score increased from -1.21 +/- 0.97 at baseline to 0.49 +/- 1.01 after the intervention (P < 0.001). CONCLUSION: This scoring system is useful to picture practice populations with diabetes who are at high cardiovascular risk because of modifiable risk factors. Although the unadjusted z-score cannot be used to compare physicians, this technique can be used to evaluate improvement efforts over time

Blood pressure · Diabetes mellitus · Disease · Family medicine · Framingham Risk Score · General practice · Gold standard (test) · Physical therapy · Receiver operating characteristic · Risk assessment · Type 2 diabetes · Computer Science · Diabetes Management and Education · Diabetes, Cardiovascular Risks, and Lipoproteins · Endocrinology · Internal Medicine · Medicine · Primary Care and Health Outcomes

• Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35)

  Open Access•Irene Stratton, I M Stratton•BMJ•2000

  Añadir item

• Effectiveness and efficiency of guideline dissemination and implementation strategies

  Open Access•Jeremy M Grimshaw, J Grimshaw et al.•Health Technology Assessment•2004

  Añadir item

• Predictors of glycemic control among patients with Type 2 diabetes

  Open Access•Stephen R Benoit, Regina K Fleming et al.•BMC Public Health•2005

  Añadir item

• Diversity in diabetes care programmes and views on high quality diabetes care

  Open Access•Liesbeth Borgermans, Geert Goderis et al.•International Journal of…•2008

  Añadir item

• Improving the Reliability of Physician Performance Assessment

  Sherrie H Kaplan, James L Griffith et al.•Medical Care•2009

  Añadir item