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Diabetes Quality Improvement Strategies of Limited Value

Team changes and case management have greater effect on glycemic control than other interventions

THURSDAY, July 27 (HealthDay News) -- Most quality improvement strategies, such as case management or patient reminder systems, result in only small to modest improvements in glycemic control in patients with type 2 diabetes, according to a study published in the July 26 issue of the Journal of the American Medical Association.

Kaveh G. Shojania, M.D., of the Ottawa Health Research Institute and Department of Medicine in Ottawa, Ontario, and colleagues used a meta-regression model with 66 trials to assess the effectiveness of 11 quality improvement strategies. The studies included patients with a mean hemoglobin A1c value of 8 percent or greater at baseline.

The researchers found two strategies resulted in a mean reduction of HbA1c by 0.50 percent or greater, and they were team changes (0.67 percent) and case management (0.52 percent). Overall, interventions reduced HbA1c values by a mean of 0.42 percent during a median 13 months of follow-up.

"Team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval," the authors conclude. "Estimates of the effectiveness of other specific quality improvement strategies may have been limited by difficulty in classifying complex interventions, insufficient numbers of studies, and publication bias."

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