Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial
Mohammed K Ali, Kavita Singh, Dimple Kondal, Raji Devarajan, Shivani A Patel, Roopa Shivashankar, Vamadevan S Ajay, A G Unnikrishnan, V Usha Menon, Premlata K Varthakavi, Vijay Viswanathan, Mala Dharmalingam, Ganapati Bantwal, Rakesh Kumar Sahay, Muhammad Qamar Masood, Rajesh Khadgawat, Ankush Desai, Bipin Sethi, Dorairaj Prabhakaran, K M Venkat Narayan, Nikhil Tandon, CARRS Trial Group, Dorairaj Prabhakaran, K.M. Venkat Narayan, K. Srinath Reddy, Nikhil Tandon, V Mohan, Mohammed Masood Kadir, Mohammed K Ali, Vamadevan S Ajay, Raji Devarajan, Roopa Shivashankar, Dimple Kondal, Shivam Pandey, Ramesh C V, Seema Shah, Prashant Tandon, Ajeet Khushwaha, Ramanathan K Ganashekaran, Anushka Patel, Ravindra Mohan Pandey, Sanjay Kalra, Mark Huffman, Pradeep Venkatesh, Sanjay Kumar Agarwal, Rohit Bhatia, Premlata K Varthakavi, Manoj D Chadha, Nikhil M Bhagwat, Roshan D’Britto, Vaibhavi Mungekar, Rohini Gajare, Abhishek Matkar, Charul Arora, Isha Verma, Yogesh Varge, Rakesh Kumar Sahay, M Neelaveni, M Prashanthi, Priyanka Parvatini, Ramachandra Reddy, Ankush Desai, Kedareshwar Narvenca, Vivek Naik, Prashant Ramesh Navelkar, Praciya Gaonkar, Rupali Naik, Santoshi Malkarnekar, Aparna Pai, Nandini Menon, Rajesh Khadgawat, Prerna Gupta, Kanika Aggarwal, Mansi Chopra, Samita Ambekar, Manish Sachdeva, Bhanvi Arora, Prashant Singh, Ganapati Bantwal, Prem Pais, Vaggesh Aiyyar, M Anantharaman, Vivek Mathew, Sudha Suresh, A G Unnikrishnan, V Usha Menon, Praveen V P, Nisha Bhavani, Nithya Abraham, Akhila Ghosh, Nimmi P V, M Kamaljith, Bipin Sethi, Mazher Ali, Pandurang Balaji, Vijay Vishwanathan, M Jai Ganesh, M Anand Kumar, M Anitha, Mala Dharmalingam, M Kavya, Muhammad Qamar Masood, Abdul Jabbar, Imran Naeem, Adeel Khan, Hassan Daudzai, Sabahat Naz, Nida Zaidi, Mohammed K Ali, Kavita Singh, Dimple Kondal, Raji Devarajan, Shivani A Patel, Roopa Shivashankar, Vamadevan S Ajay, A G Unnikrishnan, V Usha Menon, Premlata K Varthakavi, Vijay Viswanathan, Mala Dharmalingam, Ganapati Bantwal, Rakesh Kumar Sahay, Muhammad Qamar Masood, Rajesh Khadgawat, Ankush Desai, Bipin Sethi, Dorairaj Prabhakaran, K M Venkat Narayan, Nikhil Tandon, CARRS Trial Group, Dorairaj Prabhakaran, K.M. Venkat Narayan, K. Srinath Reddy, Nikhil Tandon, V Mohan, Mohammed Masood Kadir, Mohammed K Ali, Vamadevan S Ajay, Raji Devarajan, Roopa Shivashankar, Dimple Kondal, Shivam Pandey, Ramesh C V, Seema Shah, Prashant Tandon, Ajeet Khushwaha, Ramanathan K Ganashekaran, Anushka Patel, Ravindra Mohan Pandey, Sanjay Kalra, Mark Huffman, Pradeep Venkatesh, Sanjay Kumar Agarwal, Rohit Bhatia, Premlata K Varthakavi, Manoj D Chadha, Nikhil M Bhagwat, Roshan D’Britto, Vaibhavi Mungekar, Rohini Gajare, Abhishek Matkar, Charul Arora, Isha Verma, Yogesh Varge, Rakesh Kumar Sahay, M Neelaveni, M Prashanthi, Priyanka Parvatini, Ramachandra Reddy, Ankush Desai, Kedareshwar Narvenca, Vivek Naik, Prashant Ramesh Navelkar, Praciya Gaonkar, Rupali Naik, Santoshi Malkarnekar, Aparna Pai, Nandini Menon, Rajesh Khadgawat, Prerna Gupta, Kanika Aggarwal, Mansi Chopra, Samita Ambekar, Manish Sachdeva, Bhanvi Arora, Prashant Singh, Ganapati Bantwal, Prem Pais, Vaggesh Aiyyar, M Anantharaman, Vivek Mathew, Sudha Suresh, A G Unnikrishnan, V Usha Menon, Praveen V P, Nisha Bhavani, Nithya Abraham, Akhila Ghosh, Nimmi P V, M Kamaljith, Bipin Sethi, Mazher Ali, Pandurang Balaji, Vijay Vishwanathan, M Jai Ganesh, M Anand Kumar, M Anitha, Mala Dharmalingam, M Kavya, Muhammad Qamar Masood, Abdul Jabbar, Imran Naeem, Adeel Khan, Hassan Daudzai, Sabahat Naz, Nida Zaidi
Abstract
Background: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia.
Objective: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes.
Design: Parallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328).
Setting: Diabetes clinics in India and Pakistan.
Patients: 1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).
Intervention: Multicomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records.
Measurements: Proportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes).
Results: Baseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction.
Limitation: Findings were confined to urban specialist diabetes clinics.
Conclusion: Multicomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics.
Primary funding source: National Heart, Lung, and Blood Institute and UnitedHealth Group.
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Source: PubMed