Closing Gaps in Diabetes Care: From Evidence to Practice

BACKGROUND: Tracking progress in diabetes care may help in evaluating the quality of efforts and identifying gaps in the care. OBJECTIVES: To demonstrate that tracking important clinical indicators of diabetes mellitus can result in improved care as well as help identify and close gaps between evidence and practice in diabetes care. SUBJECTS AND METHODS: The study is an observational, random audit of medical records of patients with diabetes who received care at the Diabetes Center, Dammam Medical Complex. Thirteen process and four outcome key performance indicators were studied using the quality improvement Plan–Do–Study–Act model, for the period between October 2012 and March 2016. Individual physician performance was also measured for the same duration. All data were benchmarked against peer organizations worldwide. RESULTS: Urine examination for proteinuria, foot examination, annual influenza vaccination, aspirin prescription, structured education, personalized nutritional advice and self-monitoring of blood glucose significantly improved between baseline and the final observation of the study (P < 0.001). The proportion of patients with hemoglobin A1c >9% decreased, and that of those who achieved the recommended levels of hemoglobin A1c (<7%), low-density lipoprotein cholesterol (<2.6 mmol/L) and blood pressure (<140/90 mmHg) significantly increased (P < 0.001). Benchmarking against peer organizations worldwide showed comparable results overall, and better results for certain indicators. CONCLUSION: Quality improvement strategies and key performance indicators can be utilized to improve the quality of diabetes care delivered, and thus reduce gaps and barriers that exist between recommended diabetes care and practice.