The Impact of Clinical Audits on Improving the Effectiveness of Type 2 Diabetes Mellitus (T2DM) CARE in Primary Health Centers. A Comprehensive Pre-post analysis through Multi-layered Intervention: The ICAE-DM CARE study protocol
Authors: Pallath Majeed Ansif , Panakaje Niyaz , Thekke Veettil Shajitha , Harikumar Kiran , Al Mujalli Hanan , Ali Shah Abdul , Jassim AlKubaisi Noora , Sameer Alnuaimi Ahmed 
Published: November 2024

Background

Conducting clinical reviews is integral to the continuous process of enhancing healthcare quality by identifying specific areas or aspects within medical services and clinical practices. These reviews involve measuring a clinical outcome or process against established evidence-based standards, aiming to spotlight discrepancies between current practice and these benchmarks to facilitate improvements in care quality. Notably, clinical reviews rely on the exceptional skill of the driving force, underscored by key elements: the clinical expertise of participants, result confidentiality, and an objective strongly linked to the professional ‘quality’.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is on the rise, especially in economically developing nations. Current research conducted in Qatar indicates a significant prevalence of diabetes mellitus within the adult population, alongside a considerable proportion of pre-diabetes cases that are likely to elevate the incidence of diabetes mellitus in the coming years. This information underscores the critical need for effective diabetes management at the primary care level, particularly for individuals with pre-diabetes. A comprehensive systematic assessment and intervention are essential to enhance diabetes care.

Methods

The proposed research will adopt a quasi-experimental design, which includes a baseline cross-sectional situational analysis conducted across 31 Primary Health Care Centers (PHCCs) prior to the intervention. The study will focus on patients aged 18 and older who have been diagnosed with Type 2 Diabetes Mellitus (T2DM), encompassing both newly diagnosed individuals and those in follow-up care, while excluding pregnant patients. A random sampling method will be utilized to ensure a representative sample size of 450 patients from the last three months of diabetes consultations. Following the identification of gaps in the situational analysis, an intervention will be implemented, after which a post-intervention cross-sectional study will be carried out using the same sample as the baseline to evaluate changes in the measured parameters. Additionally, a cohort study will be performed through a telephonic survey of a random sample of 60 patients, both before and after the intervention, to assess changes from the patients’ perspective.

Discussion

A comprehensive assessment and intervention are essential to evaluate the quality of diabetes care delivered at primary health centers. The ICAE-DM CARE study aims to provide an effective situational analysis, which will include the identification of gaps and the underlying causes of these gaps in the DM care using suitable quality improvement tools. The study will also showcase appropriate intervention strategies to improve practice. Furthermore, the implications of this process will be thoroughly examined. This study design will closely reflect a practical understanding of healthcare quality management in diabetes care, which can be applied in similar settings.