Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena

Introduction

The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness’ care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care.

Objective

Analysing the quality of healthcare provided to DM2 patients.

Design

Quasiexperimental study before and after intervention with a not randomised control group.

Location

Health care district of primary care Sevilla.

Participants

12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way.

Intervention

Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital.

Main measurements

Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF).

Results

1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c < 7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p = 0.01) and retinography requested (p = 0.01).

Conclusions

IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect.