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Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?

BACKGROUND: The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Labo...

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Autores principales: Van Casteren, Viviane F. A., Bossuyt, Nathalie H. E., Moreels, Sarah J. S., Goderis, Geert, Vanthomme, Katrien, Wens, Johan, De Clercq, Etienne W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499949/
https://www.ncbi.nlm.nih.gov/pubmed/26171143
http://dx.doi.org/10.1186/s13690-015-0080-1
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author Van Casteren, Viviane F. A.
Bossuyt, Nathalie H. E.
Moreels, Sarah J. S.
Goderis, Geert
Vanthomme, Katrien
Wens, Johan
De Clercq, Etienne W
author_facet Van Casteren, Viviane F. A.
Bossuyt, Nathalie H. E.
Moreels, Sarah J. S.
Goderis, Geert
Vanthomme, Katrien
Wens, Johan
De Clercq, Etienne W
author_sort Van Casteren, Viviane F. A.
collection PubMed
description BACKGROUND: The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care. METHODS: This observational study took place in the period 2006–2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders. RESULTS: By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion. CONCLUSIONS: According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.
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spelling pubmed-44999492015-07-14 Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients? Van Casteren, Viviane F. A. Bossuyt, Nathalie H. E. Moreels, Sarah J. S. Goderis, Geert Vanthomme, Katrien Wens, Johan De Clercq, Etienne W Arch Public Health Research BACKGROUND: The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care. METHODS: This observational study took place in the period 2006–2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders. RESULTS: By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion. CONCLUSIONS: According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive. BioMed Central 2015-07-13 /pmc/articles/PMC4499949/ /pubmed/26171143 http://dx.doi.org/10.1186/s13690-015-0080-1 Text en © Van Casteren et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Van Casteren, Viviane F. A.
Bossuyt, Nathalie H. E.
Moreels, Sarah J. S.
Goderis, Geert
Vanthomme, Katrien
Wens, Johan
De Clercq, Etienne W
Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title_full Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title_fullStr Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title_full_unstemmed Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title_short Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
title_sort does the belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499949/
https://www.ncbi.nlm.nih.gov/pubmed/26171143
http://dx.doi.org/10.1186/s13690-015-0080-1
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