Diabetes Quality Improvement: Rigor and Ridicule

At least three distinct components are necessary to improve the quality of care. First, improving care requires adequate resources and infrastructure. Second, those in positions of authority must have the will to improve care. Finally (and perhaps most importantly), there must be a compelling rationale for improvement, a gap between where we are and where we should be.

Most of the literature on quality improvement in both the lay and professional press has focused on the first two issues. For example, to improve care, one must first have the ability to measure and track variables that are deemed important. In diabetes, for example, it may be desirable to track such variables as glycemic control, blood pressure control, lipid control, smoking, microalbuminuria, eye and foot exams, and use of angiotensin-converting enzyme inhibitors.

This kind of information (often presented via “dashboards” in electronic health records) allows physicians the ability to know both individual and population-level data on the patients they for whom they care. A vast, diverse, and largely intuitive literature exists on how this information can be used to influence behavior for the purpose of improvement. The challenge, of course, is getting access to electronic health records …