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Wu Y, Ye R, Sun C, Meng S, Cai Z, Li L, Sylvia S, Zhou H, Pappas L, Rozelle S. Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China. Front Public Health 2022; 10:1081239. [PMID: 36620284 PMCID: PMC9815030 DOI: 10.3389/fpubh.2022.1081239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Methods Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. Results A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = -1.03, 95%: -1.95, -0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly. Conclusion The quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.
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Affiliation(s)
- Yuju Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixue Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sha Meng
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhengjie Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhua Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Huan Zhou ✉
| | - Lucy Pappas
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
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Hall AK, Schumacher DJ, Thoma B, Caretta-Weyer H, Kinnear B, Gruppen L, Cooke LJ, Frank JR, Van Melle E. Outcomes of competency-based medical education: A taxonomy for shared language. MEDICAL TEACHER 2021; 43:788-793. [PMID: 34038673 DOI: 10.1080/0142159x.2021.1925643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As the global transformation of postgraduate medical training continues, there are persistent calls for program evaluation efforts to understand the impact and outcomes of competency-based medical education (CBME) implementation. The measurement of a complex educational intervention such as CBME is challenging because of the multifaceted nature of activities and outcomes. What is needed, therefore, is an organizational taxonomy to both conceptualize and categorize multiple outcomes. In this manuscript we propose a taxonomy that builds on preceding works to organize CBME outcomes across three domains: focus (educational, clinical), level (micro, meso, macro), and timeline (training, transition to practice, practice). We also provide examples of how to conceptualize outcomes of educational interventions across medical specialties using this taxonomy. By proposing a shared language for outcomes of CBME, we hope that this taxonomy will help organize ongoing evaluation work and catalyze those seeking to engage in the evaluation effort to help understand the impact and outcomes of CBME.
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Affiliation(s)
- Andrew K Hall
- Department of Emergency Medicine, Queen's University, Kingston, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Holly Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Larry Gruppen
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lara J Cooke
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jason R Frank
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Family Medicine, Queen's University, Kingston, Canada
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Riordan F, McHugh SM, O'Donovan C, Mtshede MN, Kearney PM. The Role of Physician and Practice Characteristics in the Quality of Diabetes Management in Primary Care: Systematic Review and Meta-analysis. J Gen Intern Med 2020; 35:1836-1848. [PMID: 32016700 PMCID: PMC7280455 DOI: 10.1007/s11606-020-05676-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite evidence-based guidelines, high-quality diabetes care is not always achieved. Identifying factors associated with the quality of management in primary care may inform service improvements, facilitating the tailoring of quality improvement interventions to practice needs and resources. METHODS We searched MEDLINE, EMBASE, CINAHL and Web of Science from January 1990 to March 2019. Eligible studies were cohort studies, cross-sectional studies and randomised controlled trials (baseline data) conducted among adults with diabetes, which examined the relationship between any physician and/or practice factors and any objective measure(s) of quality. Studies which examined patient factors only were ineligible. Where possible, data were pooled using random-effects meta-analysis. RESULTS In total, 82 studies were included. The range of individual quality measures and the construction of composite measures varied considerably. Female physicians compared with males ((odds ratio (OR) = 1.07, 95% CI: 1.04, 1.10), 8 studies), physicians with higher diabetes volume compared with lower volume (OR = 1.24, 95% CI: 1.05-1.47, 4 studies) and practices with Electronic Health Records (EHR) versus practices without (OR = 1.43, 95% CI: 1.11-1.84, 4 studies) were associated with a higher quality of care. There was no association between physician experience, practice location and type of practice and quality. Based on the narrative synthesis, increasing physician age and higher practice socio-economic deprivation may be associated with lower quality of care. DISCUSSION Identification of physician- and practice-level factors associated with the quality of care (female gender, younger age, physician-level diabetes volume, practice deprivation and EHR use) may explain differences across practices and physicians, provide potential targets for quality improvement interventions and indicate which practices need specific supports to deliver improvements in diabetes care.
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Affiliation(s)
- F Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - S M McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | | | - Mavis N Mtshede
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Wong CKH, Fung CSC, Yu EYT, Wan EYF, Chan AKC, Lam CLK. Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: A population-based retrospective cohort study after implementation of a quality improvement initiative. Diabetes Metab Res Rev 2018; 34. [PMID: 28925010 DOI: 10.1002/dmrr.2952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study examined whether temporal trends exist in treatment of patients with type 2 diabetes (T2D) and quality of diabetes care after implementation of quality improvement initiative in primary care setting. METHODS We conducted a population-based retrospective cohort study of 202,284 patients with T2D who were routinely managed in primary care clinics. We examined the change over time and the variability between clinics in quality of care from Hospital Authority administrative data over a 5-year period (2009-2013) and used multilevel logistic regression to adjust for patient and clinic characteristics. Observational period was partitioned in 5 calendar years. Ten quality-of-care criteria were selected: adherence to 7 process of care criteria (HbA1c test, renal function test, full lipid profile, urine protein analysis, retinal screening, lipid-lowering agent prescriptions among patients with hypercholesterolaemia, and angiotensin converting enzyme inhibitor/angiotensin receptor blocker prescriptions among patients with microalbuminuria) and 3 outcome of care criteria (HbA1c ≤ 7%, BP ≤ 130/80 mmHg, and LDL-C ≤ 2.6 mmol/L). Variability of standards between clinics was assessed by using intracluster correlation coefficients. RESULTS Characteristics of patients with T2D managed in primary care changed substantially during the observational period, with increasing age and usage of insulin and longer duration of diabetes but improved metabolic profiles (all P trend < .001). Performance rates of the 7 process and 3 clinical outcomes of care criteria increased remarkably over time (all P trend < .001). Variations in retinal screening delivery between clinics were considerable, albeit decreasing over time. CONCLUSIONS Coinciding with implementation of quality improvement initiative, quality of diabetes care improved significantly in the past 5 years, in part attributable to benefits of integrated multidisciplinary diabetes management.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Colman S C Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Esther Y T Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Anca K C Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
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