Evaluating Benchmarking to Optimize Management of Type 2 Diabetes Patients: The Belgian Data of the Optimise study

Abstract

Background Micro- and macrovascular complications of diabetes have an important impact on survival, quality of life and health care costs. Effective treatments and lifestyle interventions reduce such burden and improve quality of care. Benchmarking, an innovative intervention technique, with the potential to further improve quality of care, incorporates the provision of feedback on physician’s individual performance compared with preset targets according to current guidelines and mean performance of a peer group.

Methods Belgium is one among 6 European countries participating in the observational OPTIMISE study (NCT00681850), other countries involved being the United Kingdom, Spain, Greece, Portugal and Luxemburg. The aim was to study the effect of benchmarking on quality of care in type 2 diabetes outpatients over a 12-month period. Physicians were randomly assigned using a cluster randomisation procedure to either receive benchmarking feedback on modifiable cardiovascular parameters of major interest (intervention group) or not (control group). All physicians continued with their routine monitoring, treatment and counseling of their patients. While benchmarking and control physicians received feedback on their patients’ cardiovascular risk factors, benchmarked physicians were provided with anonymous additional information on their achieved control level for these risk factors as compared to their colleagues. The parameters of primary interest were percentage of patients achieving preset targets according to European guidelines (2007) for HbA1c (<7%), low-density lipoprotein cholesterol (LDL-C <80 mg/dl) and systolic blood pressure (SBP <130 mmHg). Follow-up (FU) markers of preventive screening, such as dietary counseling, smoking habits, physical activity, were also evaluated as secondary targets. The results presented here represent the Belgian final data.

Results 95 GPs with 1142 patients were randomized to the intervention group and 95 GPs with 1036 patients to the control group. Both groups were highly-comparable regarding all baseline demographic anthropometric and diabetes-related parameters. The frequency of patients reaching SBP target and LDL-C target after 12 months FU was increased by benchmarking (41.7% vs. 30.5%; p=0.003) for SBP, and 41.1% vs. 35.3%; p=0.011 for the LDL-C target. The frequency of patients reaching HbA1c target after 12 months FU was not significantly different in the two groups (benchmarking 62.1% vs. 63.8%). The number of patients achieving all 3 targets (LDL-C, HbA1c, SBP) increased after 12 months of follow-up and was higher in the benchmarking group (8.6% vs. 4.9%, p=0.001).

Conclusions The Final Belgian results of the OPTIMISE study show that benchmarking may impact in a positive way target attainment of three combined major cardiovascular variables (SBP, HbA1c and LDL-C) in type 2 diabetes patients. Benchmarking is therefore a promising emerging tool for quality improvement in diabetes care.