Better HbA1c and blood pressure control in patients with diabetes mellitus treated at a primary health care level 10 years after initiation of a diabetes quality improvement program.

OBJECTIVE: Deutsche BKK, a German health insurance company, initiated in 1997 a diabetes quality improvement programme. Changes in HbA (1c) and blood pressure (BP) from 1997 to 2006 are presented.

METHODS: Between 1997 to 2006 n=15 096 patients with diagnosed type 1 (6.7%) or type 2 (91.4%) diabetes were recruited by 351 primary care physicians. HbA (1c), BP, serum creatinine, microalbuminuria and presence of diabetic complications (nephropathy, retinopathy, neuropathy) were documented once per year. Physicians received an extra payment of Euro 25 as an incentive for each enrolled and examined participant.

RESULTS: Systolic BP decreased by 10.5 ± 0.9 mmHg (baseline 149 ± 21.5), diastolic BP by 4.0 ± 0.46 mmHg (baseline 82.8 ± 10.6), HbA (1c) by 0.55 ± 0.069% (baseline 7.62 ± 1.63) and more patients achieved acceptable HbA (1c) <7% (42.5 vs. 59.9%) and BP <140/90 mmHg (84.9 vs. 94.6%).

CONCLUSIONS: HbA (1c) and BP of patients with diabetes mellitus improved while participating in a yearly structured screening programme, performed by primary care physicians in a health insurance initiated quality improvement programme. The intense monitoring derives from extra remuneration of the physicians and the patients' involvement in the quality assurance process. The pre-requisite for remuneration is that the data sheet must be signed by both patient and physician.