Integrated quality assessment for diabetes care in Portuguese primary health care using prevention quality indicators

  • A. Ramalho
    Correspondence
    Corresponding author at: MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
    Affiliations
    MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal

    ACHE – American College of Healthcare Executives, Chicago, IL, USA
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  • P. Castro
    Affiliations
    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal

    USF Camélias, ACeS Gaia – Grande Porto VII (ARS Norte) – Vila Nova de Gaia, Portugal
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  • M. Lobo
    Affiliations
    MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal
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  • J. Souza
    Affiliations
    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal
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  • P. Santos
    Affiliations
    MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal
    Search for articles by this author
  • A. Freitas
    Affiliations
    MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

    CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal
    Search for articles by this author
Published:January 10, 2021DOI:https://doi.org/10.1016/j.pcd.2021.01.001

      Highlights

      • Quality indicators are an essential way for the assessment of DM in PHC.
      • Integrated analysis of indicators can provide relevant information for planning.
      • Long-term DM complications are a frequent cause of hospitalizations.
      • Controls of blood glucose levels are associated with fewer hospitalizations for DM.

      Abstract

      Aims

      This study evaluates the prevention quality indicators (PQI) for Diabetes Mellitus (DM) in Portugal using contemporary data and explores their variability according to Primary Health Care (PHC) quality indicators.

      Methods

      We conducted a retrospective observational analysis of secondary data comprising Portuguese PHC indicators by health centres group (ACES) and the National Hospital Morbidity Database. We calculated and analysed age-sex-adjusted rates for each PQI. Worse-performing ACES were identified using the 2017 median PQI values as an assessment cut-off. A multivariate logistic analysis was carried to find variables associated with the likelihood of being a worse-performing ACES for the biennium.

      Results

      The median values of the indicator PQI93 - Prevention Quality Diabetes Composite were 79 and 65.2 hospitalizations per 100 000 pop, in 2016 and 2017 respectively. Diabetes long term complications (PQI 03) accounted for most of the hospitalizations. The quality indicator in PHC with greater influence on PQI93 was the proportion of DM patients with <65 years with test results for HbA1c < = 6.5%.

      Conclusions

      This study shows that some PHC quality indicators are closely related to DM care, and so their monitoring is of high importance. Diabetes long term complications (PQI 03) demand greater attention from PHC professionals.

      Keywords

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