Adherence to quality of care measurements among 58,182 patients with new onset diabetes and its association with mortality

PLoS One. 2018 Dec 12;13(12):e0208539. doi: 10.1371/journal.pone.0208539. eCollection 2018.

Abstract

Objectives: Disease registry for diabetes care encourages transparency and benchmarking of quality of care (QoC) measurements for all service providers and seems to improve diabetes care. This study evaluate changes over time in QoC measurement performance in a large diabetes registry among newly diagnosed diabetics and it association with mortality.

Methods: Retrospective cohort study of patients in a large health maintenance organization diabetes registry from years 2000 to 2013. We identified 58,182 patients diagnosed with diabetes from 2000-2008 and examined the level of performance for seven QoC measurements (HbA1c, LDL, albumin-creatinine-ratio, fundus/foot examinations, BMI and Blood-pressure) at diagnosis year. We also searched data regarding visits to dietitians or endocrinologists, and purchase of diabetes and statin medications. We used Mantel-Haenszel's χ2 test to assess QoC performance and mortality rate by calendar year of entry into the registry, and Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality up to 5 years from diagnosis adjusted for age, gender, socio-economic status and comorbidities.

Results: The total QoC measurements improved from a mean of 2.71 tests performed in 2000 to 5.69 in 2008 (p<0.001). The mortality rate dropped from 7.7% in 2000 to 5.7% in 2008 (p<0.001). Patients with more QoC measurements performance who visited a dietitian and purchased statin medications had a lower mortality risk (HRs (95% CIs) 0.89 (0.87-0.92), 0.83 (0.76-0.91) and 0.70(0.65-0.75) respectively). Visits to endocrinologists and purchases of oral diabetes medication and insulin were associated with a higher risk of mortality (HRs (95% CIs) 1.20(1.07-1.35), 1.35(1.26-1.46) and 3.36(2.92-3.87) respectively).

Conclusion: Performance of QoC measurements including visiting a dietitian and purchase of statin medications were associated with lower mortality in patients with diabetes. It may be that the early active involvement of the patients in their care plays a protective role in long term mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Pressure
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / mortality
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Quality of Health Care*
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Adherence and Compliance*

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents

Grants and funding

This study was funded by the Chief-Physician of Maccabi Healthcare Services (MHS) (8733101). The MHS provided funding for statistical analysis assistance to author DG. The funder did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.