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Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium

Patricia Sunaert UGent, Hilde Bastiaens, Frank Nobels, Luc Feyen UGent, Geert Verbeke, Etienne Vermeire, Jan De Maeseneer UGent, Sara Willems UGent and An De Sutter UGent (2010) BMC HEALTH SERVICES RESEARCH. 10(207).
abstract
Background: During a four-year action research project (2003-2007), a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC) score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM) elements on the quality of diabetes care in a country where the efforts to adapt primary care to a more chronic care oriented system are still at a starting point. Methods: A quasi-experimental study design involving a control region with comparable geographical and socioeconomic characteristics and health care facilities was used to evaluate the effect of the intervention in the region. In collaboration with the InterMutualistic Agency (IMA) and the laboratories from both regions a research database was set up. Study cohorts in both regions were defined by using administrative data from the Sickness Funds and selected from the research database. A set of nine quality indicators was defined based on current scientific evidence. Data were analysed by an institution experienced in longitudinal data analysis. Results: In total 4,174 type 2 diabetes patients were selected from the research database; 2,425 patients (52.9% women) with a mean age of 67.5 from the intervention region and 1,749 patients (55.7% women) with a mean age of 67.4 from the control region. At the end of the intervention period, improvements were observed in five of the nine defined quality indicators in the intervention region, three of which (HbA1c assessment, statin therapy, cholesterol target) improved significantly more than in the control region. Mean HbA1c improved significantly in the intervention region (7.55 to 7.06%), but this evolution did not differ significantly (p = 0.4207) from the one in the control region (7.44 to 6.90%). The improvement in lipid control was significantly higher (p = 0.0021) in the intervention region (total cholesterol 199.07 to 173 mg/dl) than in the control region (199.44 to 180.60 mg/dl). The systematic assessment of long-term diabetes complications remained insufficient. In 2006 only 26% of the patients had their urine tested for micro-albuminuria and only 36% had consulted an ophthalmologist. Conclusion: Although the overall ACIC score increased from 1.45 to 5.5, the improvement in the quality of diabetes care was moderate. Further improvements are needed in the CCM components delivery system design and clinical information systems. The regional networks, as they are financed now by the National Institute for Health and Disability Insurance (NIHDI), are an opportunity to explore how this can be achieved in consultation with the GPs. But it is clear that, simultaneously, action is needed on the health system level to realize the installation of an accurate quality monitoring system and the necessary preconditions for chronic care delivery in primary care (patient registration, staff support, IT support).
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
QUALITY, HEALTH-CARE, INTERVENTIONS, PERFORMANCE, EXPERIENCE, COUNTY, PAY, UK
journal title
BMC HEALTH SERVICES RESEARCH
BMC Health Serv. Res.
volume
10
issue
207
article number
207
pages
11 pages
Web of Science type
Article
Web of Science id
000282800000002
JCR category
HEALTH CARE SCIENCES & SERVICES
JCR impact factor
1.721 (2010)
JCR rank
33/71 (2010)
JCR quartile
2 (2010)
ISSN
1472-6963
DOI
10.1186/1472-6963-10-207
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
1014550
handle
http://hdl.handle.net/1854/LU-1014550
date created
2010-07-27 12:22:12
date last changed
2017-03-07 12:06:06
@article{1014550,
  abstract     = {Background: During a four-year action research project (2003-2007), a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC) score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM) elements on the quality of diabetes care in a country where the efforts to adapt primary care to a more chronic care oriented system are still at a starting point.
Methods: A quasi-experimental study design involving a control region with comparable geographical and socioeconomic characteristics and health care facilities was used to evaluate the effect of the intervention in the region. In collaboration with the InterMutualistic Agency (IMA) and the laboratories from both regions a research database was set up. Study cohorts in both regions were defined by using administrative data from the Sickness Funds and selected from the research database. A set of nine quality indicators was defined based on current scientific evidence. Data were analysed by an institution experienced in longitudinal data analysis.
Results: In total 4,174 type 2 diabetes patients were selected from the research database; 2,425 patients (52.9\% women) with a mean age of 67.5 from the intervention region and 1,749 patients (55.7\% women) with a mean age of 67.4 from the control region. At the end of the intervention period, improvements were observed in five of the nine defined quality indicators in the intervention region, three of which (HbA1c assessment, statin therapy, cholesterol target) improved significantly more than in the control region. Mean HbA1c improved significantly in the intervention region (7.55 to 7.06\%), but this evolution did not differ significantly (p = 0.4207) from the one in the control region (7.44 to 6.90\%). The improvement in lipid control was significantly higher (p = 0.0021) in the intervention region (total cholesterol 199.07 to 173 mg/dl) than in the control region (199.44 to 180.60 mg/dl). The systematic assessment of long-term diabetes complications remained insufficient. In 2006 only 26\% of the patients had their urine tested for micro-albuminuria and only 36\% had consulted an ophthalmologist.
Conclusion: Although the overall ACIC score increased from 1.45 to 5.5, the improvement in the quality of diabetes care was moderate. Further improvements are needed in the CCM components delivery system design and clinical information systems. The regional networks, as they are financed now by the National Institute for Health and Disability Insurance (NIHDI), are an opportunity to explore how this can be achieved in consultation with the GPs. But it is clear that, simultaneously, action is needed on the health system level to realize the installation of an accurate quality monitoring system and the necessary preconditions for chronic care delivery in primary care (patient registration, staff support, IT support).},
  articleno    = {207},
  author       = {Sunaert, Patricia and Bastiaens, Hilde and Nobels, Frank and Feyen, Luc and Verbeke, Geert and Vermeire, Etienne  and De Maeseneer, Jan and Willems, Sara and De Sutter, An},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {QUALITY,HEALTH-CARE,INTERVENTIONS,PERFORMANCE,EXPERIENCE,COUNTY,PAY,UK},
  language     = {eng},
  number       = {207},
  pages        = {11},
  title        = {Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium},
  url          = {http://dx.doi.org/10.1186/1472-6963-10-207},
  volume       = {10},
  year         = {2010},
}

Chicago
Sunaert, Patricia, Hilde Bastiaens, Frank Nobels, Luc Feyen, Geert Verbeke, Etienne Vermeire, Jan De Maeseneer, Sara Willems, and An De Sutter. 2010. “Effectiveness of the Introduction of a Chronic Care Model-based Program for Type 2 Diabetes in Belgium.” Bmc Health Services Research 10 (207).
APA
Sunaert, P., Bastiaens, H., Nobels, F., Feyen, L., Verbeke, G., Vermeire, E., De Maeseneer, J., et al. (2010). Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium. BMC HEALTH SERVICES RESEARCH, 10(207).
Vancouver
1.
Sunaert P, Bastiaens H, Nobels F, Feyen L, Verbeke G, Vermeire E, et al. Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium. BMC HEALTH SERVICES RESEARCH. 2010;10(207).
MLA
Sunaert, Patricia, Hilde Bastiaens, Frank Nobels, et al. “Effectiveness of the Introduction of a Chronic Care Model-based Program for Type 2 Diabetes in Belgium.” BMC HEALTH SERVICES RESEARCH 10.207 (2010): n. pag. Print.