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Title: Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study
Authors: Bodicoat, Danielle H.
Mundet, Xavier
Gray, Laura J.
Cos, Xavier
Davies, Melanie J.
Khunti, Kamlesh
Cano, Juan-Franciso
GEDAPS Study Group
First Published: 29-Sep-2014
Publisher: Wiley Blackwell Publishing
Citation: Journal of Evaluation in Clinical Practice, 2014, 20 (6), pp. 1137-1143
Abstract: RATIONALE, AIMS AND OBJECTIVES: Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. METHODS: Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. RESULTS: The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. CONCLUSIONS: The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus.
DOI Link: 10.1111/jep.12253
ISSN: 1356-1294
eISSN: 1365-2753
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2014, Wiley Blackwell Publishing. Deposited with reference to the publisher’s archiving policy available on the SHERPA/RoMEO website.
Description: 12 month embargo
Appears in Collections:Published Articles, Dept. of Health Sciences

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