Quality of diabetes care predicts the development of cardiovascular events: results of the QuED study |
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Authors: | De Berardis Giorgia Pellegrini Fabio Franciosi Monica Belfiglio Maurizio Di Nardo Barbara Greenfield Sheldon Kaplan Sherrie H Rossi Maria C E Sacco Michele Tognoni Gianni Valentini Miriam Nicolucci Antonio;QuED Study Group |
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Institution: | aDepartment of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 S. Maria Imbaro (CH), Italy;bCenter for Health Policy Research, University of California, Irvine, Irvine, CA, USA |
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Abstract: | Background and aimIn the context of the QuED Study we assessed whether a quality of care summary score was able to predict the development of cardiovascular (CV) events in patients with type 2 diabetes.Methods and resultsThe score was calculated using process and intermediate outcome indicators (HbA1c, blood pressure, low-density lipoprotein cholesterol, microalbuminuria) and ranged from 0 to 40. Overall, 3235 patients were enrolled, of whom 492 developed a CV event after a median follow-up of 5 years. The incidence rate (per 1000 person-years) of CV events was 62.4 in patients with a score ≤10, 54.8 in those with a score between 15 and 20, and 39.8 in those with a score >20. In adjusted multilevel regression models, the risk to develop a CV event was 89% greater in patients with a score of ≤10 (rate ratio RR] = 1.89; 95% confidence interval CI] 1.43–2.50) and 43% higher in those with a score between 10 and 20 (RR = 1.43; 95% CI 1.14–1.79), as compared to those with a score >20. A difference between centers of 5 points in the mean quality score was associated with a difference of 16% in CV event risk (RR = 0.84; 95% CI 0.72–0.98).ConclusionOur study documented for the first time a close relationship between a score of quality of diabetes care and long-term outcomes. |
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Keywords: | Type 2 diabetes Quality of care Cardiovascular event Prediction score Process indicators Outcome indicators |
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