Overall quality of diabetes care in a defined geographic region: different sides of the same story

Background In diabetes care, knowledge about what is achievable in primary and secondary care is important. There is a need for an objective method to assess the quality of care in different settings. A quality-of-care summary score has been developed based on process and outcome measures. An adapted version of this score was used to evaluate diabetes management in different settings. Aim To evaluate the quality of diabetes management in primary and secondary care in a defined geographic region in the Netherlands, using a quality score. Design of study Cross-sectional study. Setting Thirty general practices in the Netherlands. Method A study of 2042 patients with type 2 diabetes (1640 primary care and 402 secondary care) was conducted. Quality of diabetes management was assessed by a score of process and outcome indicators (range 0 ‐40). Clustering at practice level and differences in patient characteristics (case mix) were taken into account. Results At the outpatient clinic, patients were younger (mean age 64.1 years, standard deviation (SD) = 12.5 years, versus mean age 67.1 years, SD = 11.7, P<0.001), had more diabetes-related complications (macrovascular: 39.7% versus 24.3%, P<0.001; and microvascular: 25.9% versus 7.3%, P<0.001), and lower quality-of-life scores (EuroQol-5D: mean = 0.60, SD = 0.29, versus mean = 0.80, SD = 0.21, P<0.001).Afteradjustingforcasemix andclustering,therewasaweakassociationbetweenthe setting of treatment and haemoglobin A1c (primary care: mean 7.1%, SD = 1.1, versus secondary care: mean 7.6%, SD = 1.2, P<0.016), and between setting and systolicbloodpressure(primary:mean145.7 mmHg,SD =19.2,versussecondarycare:147.77mmHg,SD21.0, P<0.035).Quality-of-caresummaryscoresinprimaryand secondarycaredifferedsignificantly,withahigherscorein primarycare(mean19.6,SD=8.5versus,mean18.1,SD =8.7, P<0.01).However,afteradjustingforcasemixand clustering,thisdifferencelostsignificance. Conclusion