A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial‐2 (J‐
            DOIT
            2)

The three-armed cluster-randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care. Trial registration: ISRCTN, ISRCTN58150046

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Development and Operationalization of a Data Framework to Assess Quality of Integrated Diabetes Care in the Fragmented Data Landscape of Belgium

10.21203/rs.3.rs-1173627/v1 ◽

2022 ◽

Author(s):

Veerle Buffel ◽

Katrien Danhieux ◽

Philippe Bos ◽

Roy Remmen ◽

Josefien Van Olmen ◽

...

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Quality Indicators ◽

Diabetes Care ◽

Care Practice ◽

Data Framework ◽

Related Quality ◽

Quality Of Diabetes Care ◽

Sampling Procedures

Abstract Background. To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape.Methods. Based on document reviews and iterative expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets.Results. To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level. Conclusion. In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.

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Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

Journal of General Internal Medicine ◽

10.1007/s11606-014-3131-3 ◽

2014 ◽

Vol 30 (4) ◽

pp. 476-482 ◽

Cited By ~ 11

Author(s):

L. Miriam Dickinson ◽

W. Perry Dickinson ◽

Paul A. Nutting ◽

Lawrence Fisher ◽

Marjie Harbrecht ◽

...

Keyword(s):

Primary Care ◽

Randomized Trial ◽

Diabetes Care ◽

Cluster Randomized Trial ◽

Primary Care Patients ◽

Cluster Randomized ◽

Improve Diabetes Care

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Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena

Antibiotics ◽

10.3390/antibiotics10101151 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1151

Author(s):

Regina Poss-Doering ◽

Dorothea Kronsteiner ◽

Martina Kamradt ◽

Petra Kaufmann-Kolle ◽

Edith Andres ◽

...

Keyword(s):

Primary Care ◽

Randomized Trial ◽

Primary Care Physicians ◽

Standard Care ◽

Cluster Randomized Trial ◽

Outcome Evaluation ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Implementation Program ◽

Cluster Randomized

The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.

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