Chronic disease management quality improvement efforts yield better care delivery

ives result in verifiable health benefits for patients as they struggle with chronic diseases, which this study confirms.

The interventions teach health center personnel quality improvement methods that require measuring quality performance and continuously implementing and refining small-scale changes that collectively result in improvements in the processes of care. Typically, quality improvement efforts target both processes, such as use of certain tests or medications, which in turn will lead to improvements in intermediate outcomes, such as control of high blood pressure. Improvements in outcomes are more difficult to achieve because of factors that may lie beyond the control of the provider, such as age of the patient or whether the patient complies with medication instructions. Experts therefore also gauge progress by measuring improvements in the processes of care as well as intermediate outcomes.

The researchers led by Bruce E. Landon, M.D., M.B.A., of the Department of Health Care Policy at Harvard Medical School, analyzed interventions with 9,658 patients at 44 health centers nationwide, approximately half of which were in urban areas. They used nationally validated quality measures that were collected from medical record reviews conducted over a 1-year period before the intervention and the same period after the intervention, and judged them against external control centers for comparison.

They found a number of process improvements:

  • A 21 percent increase in foot examinations for patients with diabetes.
  • A 14 percent increase in the use of anti-inflammatory medication for patients with asthma.
  • A 16 percent increase in the level of screening for glycated hemoglobin in persons with diabetes mellitus.
  • Overall across the three conditions, a 6 percent improvement in processes of care related to screening and disease prevention and a 5 percent improvement in processes related to dise

Contact: AHRQ Public Affairs
Harvard Medical School

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