Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care
A Randomized Controlled Trial of Quality Assurance in Sixteen Ambulatory Care Practices
A crossover r and omized controlled trial of cycles of quality assurance in 16 primary care ( 8 medical , 8 pediatric ) group practice s was conducted . Of four medical and four pediatric tasks important to patient outcome , two were r and omly assigned to experimental intervention ( a quality assurance cycle ) , and two were also measured and used as blinded controls for each medical or pediatric group practice . Task performance was measured in each group for 12 months prior to , 9 months during , and 9 months after the experimental intervention , using as a performance score the percentage of evaluation criteria failed of those applicable to a case . As a result of quality assurance intervention , quality of performance was significantly improved in two of the tasks ( P<0.0001 , with 6.7 , and 9.8 percentage points improvement ) , and marginally improved in one task ( P=0.06 , 5.7 percentage points improvement ) . Surprisingly , tasks with lower perceived effect on patient health ( low physician motivation ) had greater improvement in quality . Unimproved tasks were associated with the perceived need for delivery system changes beyond the immediate control of the individual practitioner
Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care