scholarly journals 2019 Endocrine Society Measures Set for Older Adults With Type 2 Diabetes Who Are at Risk for Hypoglycemia

2019 ◽  
Vol 105 (4) ◽  
pp. 969-990
Author(s):  
James L Rosenzweig ◽  
Paul R Conlin ◽  
Jasmine D Gonzalvo ◽  
Stephanie B Kutler ◽  
Nisa M Maruthur ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Primary Care ◽  
Quality Of Care ◽  
Primary Care Physicians ◽  
Negative Impact ◽  
Quality Measures ◽  
Endocrine Society

Abstract Context Hypoglycemia in the outpatient setting has a significant financial impact on the health care system and negative impact on a person’s quality of life. Primary care physicians must address a multitude of issues in a visit with a person with type 2 diabetes mellitus (T2DM), often leaving little time to ask about hypoglycemia. Objective To develop quality measures that focus on outpatient hypoglycemia episodes for patients 65 and older with T2DM, which facilitate a clinician’s ability to identify opportunities to improve the quality of care and reduce hypoglycemic episodes. Participants and Process A technical expert panel established by the Endocrine Society in March 2019, which includes endocrinologists, primary care physicians, a diabetes care and education specialist/pharmacist, and a patient, developed 3 outpatient hypoglycemia quality measures. The measure set is intended to improve quality of care for patients with T2DM who are at greatest risk for hypoglycemia. The measures were available for public comment in July 2019. A fourth measure on shared decision-making was removed from the final measure set based on public feedback. Conclusion A lack of outpatient hypoglycemia measures focusing on older adults with T2DM is a barrier to improving care of people with diabetes and reducing hypoglycemic episodes. This paper provides measure specifications for 3 measures that may be used to focus quality improvement efforts on patients at greatest risk for hypoglycemia.

scholarly journals Prevalence of amputations amongst people with type 2 diabetes enrolled in primary care in England

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B Meza-Torres ◽  
C Heiss ◽  
S Cunningham ◽  
F Carinci ◽  
S de Lusignan
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Quality Of Care ◽  
General Practitioners ◽  
Distinct Pattern ◽  
National Database ◽  
Cross Sectional ◽  
Clinical Records

Abstract Background Different patterns of co-morbidities observed among people with type 2 diabetes (T2D) and lower extremity amputations (LEA) compared with those without may provide insights into the quality of care provided by general practitioners in England. We analysed routinely recorded clinical data to build predictive models for benchmarking and continuous improvement. Methods A cross-sectional computerized data extraction of clinical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database of people with T2D in England. Key target cases were defined as adults with T2D and a record of major/minor LEA between 2008-2019 vs all subjects with T2D without amputation. Quality of care was assessed in terms of percentage of patients treated with optimal medical therapy and diagnostic procedures and referred to specialized care according to their clinical profile. The association between quality of care and outcomes was explored using a logistic regression model, adjusting for case-mix. Results During the last decade, in a sample covering approximately 7.4% of all general practitioners in England, a total of 1,052 subjects out of 127,100 adults with T2D had a LEA (832 per 100,000). The median time since amputation was 3.4 years. Only 410 (38%) patients had a recorded DFU diagnosis prior to the amputation, with a median of 2 years from diagnosis to amputation. Major LEA was recorded in 280 (27%) cases. People with a record of retinopathy, peripheral arterial disease, renal disease, neuropathy and DFU had a higher risk of amputations. Quality of care was heterogeneous between patients with and without LEA. Conclusions People with T2D and LEA have a distinct pattern of co-morbidities some of which may be sensitive to improved primary care management, and differential quality of care. Models built using this national database can routinely monitor amputations in England. Variation in treatment should be properly investigated. Key messages The automated extraction of clinical cases from a national database may help shed light on clinical patterns among people with diabetes at high risk of amputations, based on evidence-based criteria. Variation in treatment and quality of care among amputated vs non-amputated subjects can be rapidly explored using a cross-sectional analysis of current records.

scholarly journals Targeting β-Cell Function Early in the Course of Therapy for Type 2 Diabetes Mellitus

2010 ◽  
Vol 95 (9) ◽  
pp. 4206-4216 ◽  
Author(s):  
Jack L. Leahy ◽  
Irl B. Hirsch ◽  
Kevin A. Peterson ◽  
Doron Schneider
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Type 2 Diabetes Mellitus ◽  
Primary Care Physicians ◽  
Clinical Implications ◽  
Β Cell ◽  
Endocrine Society ◽  
Writing Group

Objective: This report examines current perspectives regarding likely mechanisms of β-cell failure in type 2 diabetes and their clinical implications for protecting or sparing β-cells early in the disease progression. In addition, it considers translation strategies to incorporate relevant scientific findings into educational initiatives targeting clinical practice behavior. Participants: On January 10, 2009, a working group of basic researchers, clinical endocrinologists, and primary care physicians met to consider whether current knowledge regarding pancreatic β-cell defects justifies retargeting and retiming treatment for clinical practice. Based on this meeting, a writing group comprised of four meeting participants subsequently prepared this consensus statement. The conference was convened by The Endocrine Society and funded by an unrestricted educational grant from Novo Nordisk. Evidence: Participants reviewed and discussed published literature, plus their own unpublished data. Consensus Process: The summary and recommendations were supported unanimously by the writing group as representing the consensus opinions of the working group. Conclusions: Workshop participants strongly advocated developing new systems to address common barriers to glycemic control and recommended several initial steps toward this goal. These recommendations included further studies to establish the clinical value of pharmacological therapies, continuing basic research to elucidate the nature and mechanisms of β-cell failure in type 2 diabetes mellitus, and exploring new educational approaches to promote pathophysiology-based clinical practices. The Endocrine Society has launched a new website to continue the discussion between endocrinologists and primary care physicians on β-cell pathophysiology in type 2 diabetes and its clinical implications. Join the conversation at http://www.betacellsindiabetes.org

scholarly journals Quality of Care for Patients With Type 2 Diabetes in Primary Care in Norway Is Improving: Results of cross-sectional surveys of 33 general practices in 1995 and 2005

Diabetes Care ◽  
2008 ◽  
Vol 32 (1) ◽  
pp. 81-83 ◽  
Author(s):  
J. G. Cooper ◽  
T. Claudi ◽  
A. K. Jenum ◽  
G. Thue ◽  
M. F. Hausken ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Quality Of Care ◽  
Cross Sectional ◽  
General Practices

scholarly journals State Funding for Health Information Technology and Selected Ambulatory Healthcare Quality Measures

2014 ◽  
Vol 05 (02) ◽  
pp. 594-602 ◽  
Author(s):  
M. Silver ◽  
R. Kaushal ◽  
L. M. Kern ◽  
Keyword(s):  
Primary Care ◽  
New York ◽  
Quality Of Care ◽  
Primary Care Physicians ◽  
New York State ◽  
Quality Measures ◽  
State Funding ◽  
Health It ◽  
York State

SummaryBackground: Previous studies on the effects of health information technology (health IT) on ambulatory quality have had mixed results. New York State has invested heavily in health IT throughout the State, creating a unique opportunity to assess effects on health care quality across multiple communities.Objective: To determine any association between primary care providers’ receipt of funding from New York State’s Healthcare Efficiency and Affordability Law for New Yorkers Program (HEAL NY) and ambulatory quality of careMethods: A statewide, longitudinal cohort study of primary care physicians in New York State was conducted. Data regarding which primary care physicians received funding through the HEAL NY program (Phase 5 or Phase 10) in 2008 or 2009 were obtained from the New York State Department of Health. Health care quality in 2010 was measured using claims data that had been aggregated across 7 commercial health plans across the state. Physicians were divided into 2 groups, based on receipt of HEAL funding (yes/no). Any association was measured between study group and each of 7 quality measures, all of which appear in the Stage 1 federal Meaningful Use program. Negative binomial regression was used, adjusting for provider gender and specialty.Results: The study included 3,988 primary care providers, of whom 863 (22%) had received HEAL NY funding. The HEAL-funded physicians provided higher quality of care on 5 of the 7 measures: breast cancer screening, eye exams in patients with diabetes, nephropathy screening in patients with diabetes, influenza vaccination and pneumococcal vaccination (p<0.0001 for all adjusted comparisons). The HEAL-funded group provided higher quality of care by an absolute 2 to 6 percentage points per measure for those 5 measures.Conclusion: Primary care physicians who received state funding for health IT provided higher quality of care than those who did not receive such funding.Citation: Kern LM, Silver M, Kaushal R; with the HITEC Investigators. State funding for health information technology and selected ambulatory healthcare quality measures. Appl Clin Inf 2014; 5: 594–602 http://dx.doi.org/10.4338/ACI-2013-12-RA-0108

Comorbidity and patient-reported quality of care: an evaluation of the primary care based German disease management program for type 2 diabetes

2011 ◽  
Vol 20 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Dominik Ose ◽  
Tobias Freund ◽  
Elisabeth Urban ◽  
Cornelia Ursula Kunz ◽  
Joachim Szecsenyi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Quality Of Care ◽  
Disease Management ◽  
Disease Management Program ◽  
Management Program ◽  
Patient Reported

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

scholarly journals Impact of electronic diabetes registry ‘Meaningful Use’ on quality of care and hospital utilization

2015 ◽  
Vol 23 (2) ◽  
pp. 242-247 ◽  
Author(s):  
Wencui Han ◽  
Raj Sharman ◽  
Arvela Heider ◽  
Nancy Maloney ◽  
Min Yang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Hierarchical Linear Modeling ◽  
Meaningful Use ◽  
Hospital Utilization ◽  
Utilization Rate ◽  
Diabetic Patients ◽  
Diabetes Registry

Abstract Objective To investigate whether the use of diabetes registries meeting Meaningful Use core objectives in primary care practices is associated with differences in quality of care and hospital utilization rates. Materials and methods A practice assessment survey was conducted to identify whether and how practices were using diabetes registries. Insurance claims data from 2010 were used to compare the health outcomes of patients from practices that used diabetes registries meeting Meaningful Use–related objectives to the outcomes of patients from other practices. Logistic hierarchical linear modeling was used to analyze the data. Results Records from 12,514 diabetic patients (including 10 809 with type 2 diabetes) from 50 urban practices were included in the analysis. The results suggest that patients with type 2 diabetes who were treated in practices using registries for patient reminders were more likely to have completed the recommended laboratory testing (odds ratio [OR] 1.26, p &lt; 0.01) and dilated retinal examinations (OR 1.14, p &lt; 0.01). Patients in practices using registries for quality improvement were less likely to have ‘avoidable hospitalization’ (OR 0.83, p &lt; 0.01) and emergency room visits (OR 0.76, p &lt; 0.01). The use of a diabetes registry did not have a significant impact on the quality of care or hospital utilization for patients with type 1 diabetes. Conclusion Use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes.

Sign in / Sign up

Export Citation Format

Share Document