Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?

Archives of Public Health

Viviane F. A. Van Casteren⁵  Nathalie H. E. Bossuyt⁵  Sarah J. S. Moreels⁵  Geert Goderis⁴  Katrien Vanthomme³  Johan Wens²  Etienne W De Clercq¹ 

[1] Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle aux Champs 30, Brussels, 1200, Belgium

[2] Universiteit Antwerpen, Academisch Centrum voor Huisartsgeneeskunde, Campus 3 Eiken, Universiteitsplein 1, Wilrijk, 2610, Belgium

[3] Vrije Universiteit Brussel, Demografie, Pleinlaan 2, Brussel, 1050, Belgium

[4] UZ Leuven - MIR (Management Informatie Rapportering, Herestraat 49, Leuven, 3000, Belgium

[5] Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, Brussels, 1050, Belgium

关键词: Chronic disease management;    Primary care;    Quality of care;    Type 2 diabetes mellitus;   

Others  :  1221373
DOI  :  10.1186/s13690-015-0080-1

 received in 2015-03-02, accepted in 2015-05-05,  发布年份 2015

【 摘 要 】

Background

The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model.

The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care.

Methods

This observational study took place in the period 2006–2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011.

Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively.

Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.

Results

By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion.

Conclusions

According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.

【 授权许可】

   
2015 Van Casteren et al.; licensee BioMed Central.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Van Der Heyden J: Contacts avec le médecin généraliste. In Enquête de santé 2013. Rapport 3 : Utilisation des services de soins de santé et des services sociaux. Edited by Drieskens S, Gisle L. WIV-ISP, Bruxelles; 2015:31-67.
• [2]Debacker N, Nobels F, Vandenberghe H, Van Combrugge P, Scheen A, Van Casteren V: Organization of a quality-assurance project in all Belgian multidisciplinary diabetes centres treating insulin-treated diabetes patients: 5 years’ experience. Diabet Med 2008, 25(2):179-85.
• [3]Doggen K, Nobels F, Scheen AJL, Van Combrugge P, Van Casteren V, Mathieu C: Cardiovascular risk factors and complications associated with albuminuria and impaired renal function in insulin-treated diabetes. J Diab Compl 2013, 27:370-5.
• [4]Doggen K, Van Acker K, Beele H, Dumont I, Félix P, Lauwers P, et al.: Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results. Diabetes Metab Res Rev 2014, 30:435-43.
• [5]Van Der Heyden J: Maladies chroniques. In Enquête de santé 2013. Rapport 1 : Santé et Bien-être. Edited by Heyden J, Charafeddine R. WIV-ISP, Bruxelles; 2014:63-225.
• [6]Goderis G, Borgermans L, Heyrman J, Van Den Broeke C, Grol R, Boland B, et al.: Type 2 diabetes in primary care in Belgium: need for structured shared care. Exp Clin Endocrinol Diabetes 2009, 117:367-72.
• [7]Goderis G, Borgermans L, Grol R, Van Den Broeke C, Boland B, Verbeke G, et al.: Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial. Diabetes Res Clin Pract 2010, 88:56-64.
• [8]Mathieu C, Nobels F, Peeters G, Van Royen P, Dirven K, Wens J, et al.: De kwaliteit en organisatie van type 2 diabeteszorg. KCE, Brussel; 2006.
• [9]Boyle PJ, O’Neil KW, Berry CA, Stowell SA, Miller SC: Improving diabetes care and patient outcomes in skilled-care communities: successes and lessons from a quality improvement initiative. J Am Med Dir Assoc 2013, 14:340-4.
• [10]Campbell DJ, Sargious P, Lewanczuk R, McBrien K, Tonelli M, Hemmelgarn B, et al.: Use of chronic disease management programs for diabetes: in Alberta’s primary care networks. Can Fam Physician 2013, 59:e86-92.
• [11]Coelho A, Leone C, Ribeiro V, Sa MP, Dussault G: Integrated disease management: a critical review of foreign and Portuguese experience. Acta Med Port 2014, 27:116-25.
• [12]Gress S, Baan CA, Calnan M, Dedeu T, Groenewegen P, Howson H, et al.: Co-ordination and management of chronic conditions in Europe: the role of primary care–position paper of the european forum for primary care. Qual Prim Care 2009, 17:75-86.
• [13]Halladay JR, Dewalt DA, Wise A, Qaqish B, Reiter K, Lee SY, et al.: More extensive implementation of the chronic care model is associated with better lipid control in diabetes. J Am Board Fam Med 2014, 27:34-41.
• [14]Hamar GB, Rula EY, Wells A, Coberley C, Pope JE, Larkin S: Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes. Popul Health Manag 2013, 16:125-31.
• [15]Katz I, Schneider H, Shezi Z, Mdleleni G, Gerntholtz T, Butler O, et al.: Managing type 2 diabetes in Soweto-the south African chronic disease outreach program experience. Prim Care Diabetes 2009, 3:157-64.
• [16]Knai C, Nolte E, Brunn M, Elissen A, Conklin A, Pedersen JP, et al.: Reported barriers to evaluation in chronic care: Experiences in six European countries. Health Policy 2013, 110:220-8.
• [17]Nagel H, Baehring T, Scherbaum WA: Implementing disease management programs for type 2 diabetes in Germany. Manag Care 2006, 15:50-3.
• [18]Nolte E, Knai C, Hofmarcher M, Conklin A, Erler A, Elissen A, et al.: Overcoming fragmentation in health care: chronic care in Austria, Germany and The Netherlands. Health Econ Policy Law 2012, 7:125-46.
• [19]Rosenzweig JL, Taitel MS, Norman GK, Moore TJ, Turenne W, Tang P: Diabetes disease management in Medicare Advantage reduces hospitalizations and costs. Am J Manag Care 2010, 16:e157-62.
• [20]Schafer I, Kuver C, Gedrose B, Hoffmann F, Russ-Thiel B, Brose HP, et al.: The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient’s experiences. BMC Health Serv Res 2010, 10:55. BioMed Central Full Text
• [21]Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002, 288:1909-14.
• [22]Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288:1775-9.
• [23]Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Q 1996, 74:511-44.
• [24]Wagner EH: Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998, 1:2-4.
• [25]Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001, 20:64-78.
• [26][http://www.zorgtraject.be/NL/index.asp] webciteRIZIV-INAMI Zorgtrajecten - Trajets de soins.,[]. http://www.trajetdesoins.be/FR/index.asp webcite
• [27]Bossuyt N, Van Casteren V, Goderis G, Wens J, Moreels S, Vanthomme K, et al. Public Health Triangulation to inform decision-making in Belgium. In Proceedings of the 26th Medical Informatics Europe Conference:27–29 May 2015; Madrid. (in press).
• [28]De Clercq E, Van Casteren V, Bossuyt N, Goderis G, Moreels S: Belgian primary care EPR: assessment of nationwide routine data extraction. Stud Health Technol Inform 2014, 197:85-9.
• [29]De Clercq E, Van Casteren V, Bossuyt N, Goderis G, Moreels S: EPR-based, quality-related process parameters: a nationwide assessment. Stud Health Technol Inform 2014, 205:121-5.
• [30]Goderis G, Van Casteren V, De Clercq E, Bossuyt N, Van den Broecke C, Vanthomme K, et al. Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study. Prim Care Diab. 2015;http://dx.doi.org/10.1016/j.pcd.2015.01.008.
• [31]Vanthomme K, Bossuyt N, Moreels S, Boffin N, De Clercq E, Goderis G, et al.: What determines inclusion in the early phase of the type 2 diabetes care trajectory in Belgium? Archives of Public Health 2014, 72:29. BioMed Central Full Text
• [32]Wens J, Sunaert P, Nobels F, Feyen L, Van Crombruggen P, Bastiaens H, et al.: Aanbeveling voor goede medische praktijkvoering: Diabetes Mellitus type 2. Berchem/Gent, Domus Medica; 2005.
• [33]Ceuppens A, Corveleyn T, Degauquier K, Vandermeersch G, Vanoverloop J, Widera I: De diabetes conventie. IMA-AIM, Brussel; 2005.
• [34]Sunaert P, Bastiaens H, Nobels F, Feyen L, Verbeke G, Vermeire E, et al.: Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium. BMC Health Serv Res 2010, 10:207. BioMed Central Full Text
• [35]Van Casteren V, Bossuyt N, Moreels S, Vanthomme K, Goderis G, De Clercq E: De zorgtrajecten diabetes mellitus type 2 en chronische nierinsufficiëntie: impact op de kwaliteit van zorg. WIV-ISP, Brussel; 2013.
• [36]De Clercq E, Van Casteren V, Bossuyt N, Moreels S, Goderis G, Bartholomeeusen S, et al.: Nation-wide primary healthcare research network: a privacy protection assessment. Stud Health Technol Inform 2012, 174:23-8.
• [37][http://www.nic-ima.be/nl/imaweb/home/index.html] webciteIMA-AIM.[],. http://www.nic-ima.be/fr/imaweb/home/index.html webcite
• [38]Truyers C, Goderis G, Dewitte H, Vanden Akker M, Buntinx F: The Intego database: background, methods and basic results of a Flemish general practice-based continuous morbidity registration project. BMC Med Inform Decis Mak 2014, 14:48. BioMed Central Full Text
• [39]Lobet MP, Stroobant A, Mertens R, Van Casteren V, Walckiers D, Masuy-Stroobant G, et al.: Tool for validation of the network of sentinel general practitioners in the Belgian health care system. Int J Epidemiol 1987, 16:612-8.
• [40]World Health Organization: HIV triangulation resource guide: synthesis of results from multiple data sources for evaluation and decision-making. World Health Organization, Geneva; 2009.
• [41]Donabedian A: The quality of care. How can it be assessed? JAMA 1988, 23:1743-8.
• [42]Bailey CJ, Del Patro S, Eddy D, Zinman B: Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract 2005, 59:1309-16.
• [43]Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359:1577-89.
• [44]Schillinger D, Barton LR, Karter AJ, Wang F, Adler N: Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep 2006, 121(3):245-54.
• [45]Schinckus L, Van den Broucke S, Housiaux M: Assessment of implementation fidelity in diabetes self-management education programs: a systematic review. Patient Educ Couns 2014, 96(1):13-21.