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.
Key words
care delivery - HbA1c
- hypertension - quality of care
References
1c values in the state of Thuringia/Germany.
Exp Clin Endocr Diab.
2004;
112
531-537
Correspondence
christof.kloos@med.uni-jena.de
