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Quality Improvement for Integrated Management of Patients With Type 2 Diabetes (PRIHTA Project Stage 1)

Paccagnella, Agostino MD; Mauri, Alessandra PSYCH; Spinella, Nello MD

doi: 10.1097/QMH.0b013e31824d1917
Original Articles

Purpose: The purpose of the study was to show how a different collaborative relationship with family doctors and increasingly specialized diabetologists could lead to a 50% reduction in recurrent appointments due to procedural errors and a 50% reduction in the average waiting times for a specialist medical visit.

Methods: A qualitative and quantitative definition of the problem was made using the Lean Six Sigma method: (Define); process indicators were observed that might interfere with the objectives of this study (Measure); descriptive statistics were used to confirm the validity and significance of the results (Analyze); and finally strategies were established to intervene on these variables (Improve).

Results: Four groups of action led to optimization of the objectives: (1) establishing clinical protocols for primary care physicians for treating hospitalized patients with type 2 diabetes and hyperglycemia; (2) increasing the autonomy of nursing care staff; (3) reorganizing the appointments booking office; and (4) making diabetes clinics more specialized.

Conclusions: Thanks to this project, primary care physicians have rediscovered their role and defined their diagnostic-therapeutic function under a shared scientific protocol. The model presented in this study provides scope for reflection on the role of the diabetologist, proposing an “alternative” that concerns only the care of patients with metabolic decompensation.

U.O. Malattie Metaboliche e Nutrizione Clinica dell'Azienda Sanitaria ULSS 9 (Metabolic Diseases and Clinical Nutrition Department of Local Health Authority ULSS 9) (Drs Agostino Paccagnella, Alessandra Mauri); Coordinamento Distretti Socio-Sanitari dell'Azienda Sanitaria ULSS 9 (Social-Health Care Districts Coordinating Body of the Local Health Authority ULSS 9) (Nello Spinella).

Correspondence: Agostino Paccagnella (

The authors declare no conflicts of interest.

The PRIHTA Study is supported by the Veneto Regional Government (Italy) and Lilly Company contracts: Code I41H10000050007 CUP (DGRV–Veneto Regional Government Resolution no. 3396 of November 10, 2009. DDG (Decree of the Director General) no. 1068 of September 9, 2010).

©2012Lippincott Williams & Wilkins, Inc.