Quality Indicators for Diabetes Care in Practice Guidelines and Applying in the District Hospital
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Abstract
This study had two main objectives. The first objective was to conduct a systematic document review to identify and summarize quality indicators of diabetes care. An electronic search of English and Thai language literature published between 1990 and 2008 was performed. Eleven established guidelines were included. Thirty-eight indicators were extracted and categorized into eight diabetes management topics: glycemic control, nephropathy assessment, lipid profile assessment, eye examination, foot examination, blood pressure control, antiplatelet use, and others. The secondary objective was to perform a cross-sectional study to describe the quality of diabetes care in term of process and outcome in two district hospitals in Amnatcharoen Province. All diabetic patients who had fasting blood sugar (FBS) monitored at least three times per year during the period 2003 to 2007, were analyzed by hospital electronic database and medical chart review. In 2003, 2004, 2005, 2006, and 2007, there were 759, 991, 1,212, 1,389, and 1,481 diabetic patients, respectively. The proportions of serum creatinine and lipid profile monitoring increased gradually over time whereas HbA1c and proteinuria monitoring was performed in a small number of cases. The hospitals began to provide complete foot examinations in 2007 and nearly half of patients were examined. The percentage of the patients receiving eye examinations varied over the years. The proportion of patients who were prescribed angiotensin-converting enzyme inhibitors improved substantially between 2003 (17%) and 2007 (49%), whereas most patients were not prescribed aspirin and statins during these years. The percentage of the patients who reached the American Diabetes Association (ADA) 2004 goals of therapy for FBS and blood pressure were relatively low over the five year period. In conclusion, most processes of diabetes care were improved over the five year period. However, there is still room for improvement in the quality of diabetes care in district hospitals. Appropriate management programs should be implemented to improve diabetes care.
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