Family Physicians’ Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Lars E. Peterson; Brenna E. Blackburn; James C. Puffer; Robert L. Phillips

doi:10.1370/afm.1592

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Table 1

Demographics of Physicians Completing the Diabetes Quality Improvement Module

Variable	Value
Age, y, mean (SD)	48.2 (9.2)
Sex, male, %	61.9
Years in practice, mean (SD)	13.8 (9.1)
Number of recertifications, mean (SD)	1.9 (1.4)
Days to complete PPM, mean (SD)	184.5 (168.2)
Practice location, %
Urban	76.9
Large rural	11.5
Small rural	7.8
Isolated	3.9

PPM = Performance in Practice module.
Note: there were 7,924 completed modules.

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Table 2

Physician Quality Measures Before and After the Intervention

Measure	Before	After^a
Hemoglobin A_1c, mean (SD), %	7.2 (1.5)	7.1 (1.3)
Hemoglobin A_1c levels in control (<7.0%), %	57.4	61.3
Foot examination performed, %	68.0	85.8
Microalbuminuria assessed, %	74.5	88.3
Smoking cessation counseling, %	87.1	93.1
Retina examination performed, %	55.5	71.1
Low-density lipoprotein cholesterol, mean (SD), mg/dL	94.7 (33.9)	93.7 (31.5)
Low-density lipoprotein cholesterol levels <100 mg/dL, %	63.1	64.6
Systolic blood pressure, mm Hg (SD)	128.9 (15.2)	127.9 (14.3)
Diastolic blood pressure, mm Hg (SD)	75.4 (9.8)	75.2 (9.4)
Systolic blood pressure <130 mm Hg and diastolic blood pressure <90 mm Hg, %	53.3	56.3

↵a All significant at P <.01.

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Table 3

Patient Quality Measures Before and After the Intervention

Patient-Reported Measure	Before, %	After, %^a
Have you had your hemoglobin A_1c (a test of how much sugar is in your blood) checked in the last 6 months?	92.4	95.9
Has your doctor checked your feet in the last 6 months?	76.5	89.7
When you see your doctor, is your blood pressure checked?	99.6	99.8
Do you know your goal blood pressure (the blood pressure you should have for good health)?	77.0	85.9
Has your doctor tested your urine for signs of diabetic kidney disease this year?	77.2	87.4
Have you had an eye exam by an eye care professional in the last 12 months?	69.5	79.4
If you smoke, has your doctor talked to you about quitting?	91.1	95.2
Have you had your cholesterol checked in the past year?	94.0	96.6

↵a All significant at P <.01.

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The Article in Brief

Family Physicians' Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Lars E. Peterson , and colleagues

Background This study examines nearly 8,000 diabetes quality improvement projects. The projects were conducted by family physicians across the United States who completed a Performance in Practice module to meet recertification requirements of the American Board of Family Medicine.

What This Study Found Nearly all projects were associated with significant and meaningful improvements in diabetes care. Successful completion of the module required quality measure abstraction from 10 patient charts before and after an improvement effort. Almost one-half of participating physicians selected diabetic foot examination or eye examination as their quality improvement measure. Other quality measures included testing for microabluminauria, checking hemoglobin A1C or lipid levels, assessing blood pressure control, and counseling for smoking cessation. Analysis showed all quality measures improved after the intervention, except measuring LDL cholesterol. In particular, foot examination documententation increased from 68 percent to 86 percent, and retina examination documentation increased from 56 percent to 71 percent. The most common interventions were standing orders and patient education.

Implications

These findings, the authors assert, add to the evidence base for integration of quality improvement into practice.