TY - JOUR
T1 - Using collaborative learning to improve diabetes care and outcomes
T2 - The VIDA project
AU - Barceló, Alberto
AU - Cafiero, Elizabeth
AU - De Boer, Melanie
AU - Mesa, Alejandro Escobar
AU - Lopez, Marcelina García
AU - Jiménez, Rosa Aurora
AU - Esqueda, Agustín Lara
AU - Martinez, José Antonio
AU - Holguin, Esperanza Medina
AU - Meiners, Micheline
AU - Bonfil, Gerson Moreno
AU - Ramirez, Saturnino Navarro
AU - Flores, Enrique Pérez
AU - Robles, Sylvia
PY - 2010/10
Y1 - 2010/10
N2 - The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200 mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology. Methods: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure. Results: The proportion of people with good glycemic control (A1c < 7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p < 0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p = 0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes. Conclusions: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
AB - The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200 mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology. Methods: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure. Results: The proportion of people with good glycemic control (A1c < 7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p < 0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p = 0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes. Conclusions: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
KW - Diabetes care
KW - Quality improvement
UR - https://www.scopus.com/pages/publications/77957372030
U2 - 10.1016/j.pcd.2010.04.005
DO - 10.1016/j.pcd.2010.04.005
M3 - Article
C2 - 20478753
AN - SCOPUS:77957372030
SN - 1751-9918
VL - 4
SP - 145
EP - 153
JO - Primary Care Diabetes
JF - Primary Care Diabetes
IS - 3
ER -
