IMPLEMENTATION OF SELF-AUDIT IN THE QUALITY CONTROL OF TYPE 2 DIABETES PATIENTS

Pedrajas J., de Diego S. y Ortega C. Health’s Center of Pozoblanco. Córdoba.Spain 2008

INTRODUCTION.

We are advancing rapidly in technology and knowledge about diabetes mellitus (DM). However, the medical personnel do not know if their everyday individual clinical practices are improving the quality of the care for these patients. As a result of this, a system of evaluation self-audit has been proposed, which intends to detect problems in our activities related to clinical practice in relation with these diabetic patients. The main objective was, after its analysis, to accomplish improvements in our clinic practices in terms of quality (structural, process and of results).The aim is to implement the self-audit in our patients with DM as a tool in the analysis of problems and of continuous improvement of quality.

RESEARCH DESIGN AND METHOD.

We performed a retrospective cross-sectional analysis of clinical records of DM patients older than 18 selected by physician. The following criteria for exclusion was established: less than 1 year of control or controlled exclusively by other professionals (hospital...) or patients in extreme situations of quality of life. We chose the quality indicators (process and result) that were in the report “Proceso de DM de la Junta de Andalucía” and if some were lacking, the most relevant indicators of clinical guidelines were used ( ADA and IDF ). This allowed us to evaluate and compare our data with the aforementioned guidelines. The data was extracted from computerised clinical records (DIRAYA).

RESULTS

We studied 109 clinical records of diabetic patients whit mean age 68,89 (31 -94) years and women was 62,4% , with the following results :

Quality Management Indicators
PROCESS / Nº of yearly visitors related with the Diabetes in medical consultation / 5.57
Nº of yearly visitors related with the Diabetes in consultation of nurse / 2.94
Glycosylated Hemoglobin (HbA1c): % of patients checked ≥ 1 per year / 66.1%
Foot Preventive Care: % of patients receive comprehensive foot exam ≥ 1 per year / 41.3%
Kidney Preventive Care: % of patients receive annual microalbuminuria exams / 73.0%
Eye Preventive Care: % of patients checked in the last ones 2 years ≥ 1 times / 12.8%
Blood Pressure Preventive Care: % of patients checked ≥ 1 times per year / 70.6%.
Lipid Assessments:% of patients have annual lipid profile / 67.9%
RESULT / Glycosylated Hemoglobin (HbA1c): % of patients < 8% / 61.5%
Blood Pressure Preventive Care: % of patients < 140/90 / 61.5%
Percent of population with diabetes who had a fasting lipid profile (LDL) correct / 45%
Prevalence lower extremity amputations / 0%
Prevalence of cardiovascular disease / 13.8%
Percent of population with diabetes have suffered for severe hypoglycaemia / 2.8%
Percent of population with diabetes have suffered for severe hyperglycemia / 2.8%
Cardiovascular Preventive Care:% of Aspirin low-dose prophylaxis people with DM / 40.4%

CONCLUSION

There should be an increase in the percentage of registered diabetic patients (in an audit, whatever is not recorded, is considered as not done) and improving the rest of the recorded indicators. We believe that the self-audit has proven to be a very useful tool for monitoring quality management indicators on an individual level and it has also helped us to improve the control of DM patient care without it taking up too much time.