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Quality Management in Health Care:
doi: 10.1097/QMH.0000000000000025
Original Articles

Analysis and Improvement of Organizational Models for the Management of Patients With Type 2 Diabetes Mellitus: A Case Study in North-east Italy

Paccagnella, A. MD; Boaretto, M. MD; Confortin, L. MD; Sambataro, M. MD; Mauri, A. PSYCH; Marcon, M.L. PgDip; Cavasin, F. MD; Chinellato, A. PHARMD; Faronato, P.P. MD; Tessarin, M. MD; Spinella, N. MD; Visentin, A. MD; Pizzolato, D. PgDip; Santelli, G. MD

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Abstract

Purpose: The study aimed to establish whether the organization for the management of type 2 diabetes mellitus at 9 diabetic units (DUs), in 5 neighboring local health authorities (LHAs), was able to (a) comply with the organizational model prescribed by specific regional standards; (b) ensure adequate clinical management of diabetic patients; (c) assess whether the relationship between primary care physicians (PCPs) and diabetologists (SDs) was instrumental to the needs of patients; (d) optimize specialist treatment at the DUs; (e) optimize drug management; and (f) check whether organizational changes led to variations in clinical results.

Methods: This 6-stage study analyzed procedures, precoded actions, and recordable processes. Stage (1) Defining clinical and organizational endpoints; (2) Drafting flowcharts to describe the actions and work procedures implemented within each LHA; (3) Comparing the flowcharts with the data obtained from related literature; (4) Establishing a protocol shared with PCPs for the management and treatment of patients with type 2 diabetes; (5) Changing the procedures at the DUs; and (6) Evaluating the results. The data were assessed before and after establishing a shared protocol for SDs and PCPs (year 2009 vs 2011).

Results: The study shows inconsistencies in the organization of work in the 5 LHAs; however, collaboration with PCPs has guaranteed: (a) unchanged hemoglobin A1C values before and after applying the protocol; (b) a percentage increase in the number of patients with type 2 diabetes who were identified thanks to these protocols; (c) an increase in the use of biguanides compared to the preprotocol period; and (d) no change in the number of patients hospitalized because of acute complications from type 2 diabetes mellitus.

Conclusions: This study confirms how adequate collaboration between SDs and PCPs keeps the risk of complications stable. Nevertheless, shared protocols and clearly defined roles are required.

© 2014Wolters Kluwer Health | Lippincott Williams & Wilkins

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