Comparisons In Quality Network Reveal Weaknesses Of Structure

Winell K, Soveri P, Heikkinen M, Matikainen M, Piironen A and Viitaniemi M.
Conmedic. Espoo (Finland).
Background. The follow-up in CQi can measure the quality of structure, process or outcome. The Finnish quality network of diabetes care strives to measure the development in all these aspects.
Design. An audit sheet was filled by all GPs and diabetic nurses for every NIDDM patient during a 14 or 21 days follow-up period depending on the size of the population of the health centre.
Does the patient have a system of home testing for blood glucose and has she attended photography for detection of vascular disease in the fundus of the eye, has glycosylated haemoglobin (HbA1c) been measured during the last six months, has microalbumin in urine been tested during the last year and has blood cholesterol been measured during the last 3 years, were the questions. These were considered to be part of the good clinical practice for diabetes care.
Results. In two centres not being part of the diabetes network HbA1c was measured in 57 and 71 % of diabetics. In one of the .diabetes centres it was measured in 73 % of cases. In all other centres the measurement was done in 82-96 % of cases. The microalbumin in urine was tested in 18-85 % of the cases. The cholesterol was measured in 71- 96 % of cases. Home testing for blood glucose was more regular in the diabetes centres (41-66 % of cases) compared with the non-diabetes quality centres (25-65 % of centres). The photography for detection of eye complications was done in three of the centres in 83 % of cases. In one of the centres only in 4 % of cases.
Conclusions. Preparing local guidelines and structures for good practice makes the basis for quality. Our study proves that it is necessary to have these guidelines to guarantee the structural quality.
Comparisons in quality network reveal weaknesses of structure