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
Is the Quality of Diabetes Care Better in a Diabetes Clinic or in a General Medicine Clinic?
OBJECTIVE To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center . RESEARCH DESIGN AND METHODS This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria . A total of 112 patients with diabetes were r and omly selected , of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic . The following main outcome measures were examined : 1 ) the compliance with individual criteria ; and 2 ) the proportion of patient visits in each clinic receiving minimally acceptable quality , defined as a blood pressure measurement , a record of type of hypoglycemic medication  , a glycated hemoglobin measurement within the past year , a urinalysis within the past year , an  ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months , a record of change in therapeutic management , and a scheduled return visit . RESULTS The diabetes clinic performed significantly better than the general medicine clinic on the following criteria : a record of a patient 's self-monitoring of blood glucose levels ; a foot examination ; a comprehensive eye examination ; a glycated hemoglobin measurement ; and a referral for diabetic education . The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic ( 73 vs. 52 % , P = 0.02 ) . CONCLUSIONS Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic . If patient care is to be shifted from specialists to generalists , additional attention needs to be paid to ensure that generalists have the knowledge and system re sources necessary to deliver an acceptable quality of diabetes care
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