Exp Clin Endocrinol Diabetes 2011; 119(8): 459-462
DOI: 10.1055/s-0031-1273746
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Better HbA1c and Blood Pressure Control in Patients with Diabetes Mellitus Treated at a Primary Health Care Level 10 Years After Initiation of a Diabetes Quality Improvement Program

C. Kloos1 , N. Müller1 , G. Wolf1 , P. Hartmann2 , T. Lehmann3 , U. A. Müller1
  • 1Department of Internal Medicine III, University Hospital, Jena, Germany
  • 2Controlling und Versorgungsmanagement, Deutsche BKK Stuttgart, Wolfsburg, Germany
  • 3Institute of Medical Statistics, Information Sciences and Documentation, University Hospital Jena, Germany
Further Information

Publication History

received 03.12.2010 first decision 21.02.2011

accepted 22.02.2011

Publication Date:
06 April 2011 (online)

Abstract

Objective: Deutsche BKK, a German health insurance company, initiated in 1997 a diabetes quality improvement programme. Changes in HbA1c and blood pressure (BP) from 1997 to 2006 are presented.

Methods: Between 1997 to 2006 n=15 096 patients with diagnosed type 1 (6.7%) or type 2 (91.4%) diabetes were recruited by 351 primary care physicians. HbA1c, BP, serum creatinine, microalbuminuria and presence of diabetic complications (nephropathy, retinopathy, neuropathy) were documented once per year. Physicians received an extra payment of Euro 25 as an incentive for each enrolled and examined participant.

Results: Systolic BP decreased by 10.5±0.9 mmHg (baseline 149±21.5), diastolic BP by 4.0±0.46 mmHg (baseline 82.8±10.6), HbA1c by 0.55±0.069% (baseline 7.62±1.63) and more patients achieved acceptable HbA1c <7% (42.5 vs. 59.9%) and BP <140/90 mmHg (84.9 vs. 94.6%).

Conclusions: HbA1c and BP of patients with diabetes mellitus improved while participating in a yearly structured screening programme, performed by primary care physicians in a health insurance initiated quality improvement programme. The intense monitoring derives from extra remuneration of the physicians and the patients’ involvement in the quality assurance process. The pre-requisite for remuneration is that the data sheet must be signed by both patient and physician.

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Correspondence

C. KloosMD 

Department of Internal

Medicine III

Endocrinology and Metabolic

Disorders

University Hospital Jena

Bachstraße 18

D–07743 Jena

Germany

Phone: +49/3641/934 843

Fax: +49/3641/933 009

Email: christof.kloos@med.uni-jena.de