While PDSA, Lean, and Six Sigma are approaches to help practices in change and overall improvement, there are several evidence-based tactics and interventions that can lead to improved outcomes when implemented in a systematic manner. The ERIC Project (Expert Recommendations for Implementing Change) (PDF, 604 KB) has compiled a list of 73 tactics to facilitate change in a variety of settings. While not every one of the approaches is useful to the improvement of diabetes care, the list is extensive and can be used as a guide for practices.
The quality improvement movement is still in its early stages. Much has yet to be learned about the optimal approaches and techniques to improve quality. Some authors have suggested significant limitations to the existing scientific basis for quality improvement and have raised the bar for future scientists and authors to be more rigorous in trial design.
Let the Evidence Guide You
Learn more about existing tools and approaches that have been shown to lead directly to improved outcomes such as A1C.
Shojania KG, Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296(4):427-40.
The TRANSLATE trial is an example of a clinical trial that has demonstrated improvement in diabetes outcomes based on changes to structures and processes in the medical office practice setting. Significant improvement in SBP, A1C, and LDL were demonstrated with the implementation of an electronic diabetes registry, visit reminders, and patient-specific physician. A site coordinator facilitated pre-visit planning and a monthly review of performance with a local physician champion. As a result, diabetes process measures increased significantly more in intervention than in control practices (total of 24 practices studied) giving net increases as follows: foot examinations 35.0% (P < 0.0.001); annual eye examinations 25.9% (P < 0.001); renal testing 28.5% (P < 0.001); A1C testing 8.1% (P < 0.001); blood pressure monitoring 3.5% (P = 0.05); and LDL testing 8.6% (P < 0.001). Mean A1C adjusted for age sex and comorbidity decreased significantly in intervention practices (P < 0.02). At 12 months, intervention practices had significantly greater improvement in achieving recommended clinical values for SBP, A1C, and LDL than control clinics (P = 0.002).
Peterson KA, Radosevich DM, O’Connor PJ, et al. Improving diabetes care in practice: findings from the TRANSLATE trial. Diabetes Care. 2008;31(12):2238-43.