Abstract
An association between variability in clinical parameters (HbA 1c , blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. RESEARCH DESIGN AND METHODS The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. RESULTS Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA 1c , blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized b coefficients show that the Q-score has a larger impact on the variability of HbA 1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). CONCLUSIONS The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.
| Original language | English |
|---|---|
| Pages (from-to) | 514-519 |
| Number of pages | 6 |
| Journal | Diabetes Care |
| Volume | 42 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 1 2019 |
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ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialised Nursing
Cite this
Overall quality of care predicts the variability of key risk factors for complications in type 2 diabetes : An observational, longitudinal retrospective study. / Ceriello, Antonio; Rossi, Maria Chiara; De Cosmo, Salvatore; Lucisano, Giuseppe; Pontremoli, Roberto; Fioretto, Paola; Giorda, Carlo; Pacilli, Antonio; Viazzi, Francesca; Russo, Giuseppina; Nicolucci, Antonio.
In: Diabetes Care, Vol. 42, No. 4, 01.04.2019, p. 514-519.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Overall quality of care predicts the variability of key risk factors for complications in type 2 diabetes
T2 - An observational, longitudinal retrospective study
AU - Ceriello, Antonio
AU - Rossi, Maria Chiara
AU - De Cosmo, Salvatore
AU - Lucisano, Giuseppe
AU - Pontremoli, Roberto
AU - Fioretto, Paola
AU - Giorda, Carlo
AU - Pacilli, Antonio
AU - Viazzi, Francesca
AU - Russo, Giuseppina
AU - Nicolucci, Antonio
PY - 2019/4/1
Y1 - 2019/4/1
N2 - An association between variability in clinical parameters (HbA 1c , blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. RESEARCH DESIGN AND METHODS The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. RESULTS Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA 1c , blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized b coefficients show that the Q-score has a larger impact on the variability of HbA 1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). CONCLUSIONS The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.
AB - An association between variability in clinical parameters (HbA 1c , blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. RESEARCH DESIGN AND METHODS The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. RESULTS Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA 1c , blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized b coefficients show that the Q-score has a larger impact on the variability of HbA 1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). CONCLUSIONS The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.
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U2 - 10.2337/dc18-1471
DO - 10.2337/dc18-1471
M3 - Article
VL - 42
SP - 514
EP - 519
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 4
ER -