Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes

Development and operationalization of a data framework to assess quality of integrated diabetes care in the fragmented data landscape of Belgium

Background

To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape.

Methods

Based on document reviews, iterative working group discussions and expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets.

Results

To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level.

Conclusion

In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08625-8.

Perceptions of professional nurses regarding the National Core Standards tool in tertiary hospitals in KwaZulu-Natal

Background

Internationally, healthcare providers share a common goal of providing safe and high-quality care to every patient. In South Africa, the National Core Standards (NCS) tool was introduced to improve the quality of healthcare delivery.

Objectives

This article is aimed to determine the perceptions of nurses concerning the use of NCS as a tool to measure quality care delivery in tertiary hospitals in KwaZulu-Natal.

Method

This was a cross-sectional descriptive survey, where a purposive sampling technique was used to select hospitals. Six strata of departments were selected using simple stratified sampling. In each stratum, every second ward was selected from the provided list of wards using a systematic random sampling. The population of professional nurses in selected departments was 3050, from which 437 participants were selected by systematic random sampling. The collected data were analysed using Statistical Package for the Social Sciences (SPSS^®) version 25.

Results

The study indicated that 53.5% respondents believed that the NCS tool allows them to identify areas of weakness, pointing to risks in basic human rights. However, only 49.7% respondents believed that the NCS tool allows staff inputs to identify relevant innovations. The study recommends improvement in the organisational climate and adoption of strategies that add value to patient care.

Conclusion

Professional nurses perceived the NCS tool as a good tool for improving quality of healthcare delivery, but there is a need to improve environmental practice and involvement of all healthcare establishments to increase its effectiveness.

Telecoaching programme for type 2 diabetes control: a randomised clinical trial

BACKGROUND:

People with diabetes have a high risk of developing micro and macrovascular complications that increase treatment costs and shorten life expectancy. Telecoaching programmes can improve short-term control of diabetes and reduce disease burden.

AIMS:

To analyse the effect of a health telecoaching programme in the control of type 2 diabetes.

METHODS:

A pragmatic clinical trial was carried out. Thirty-one patients with type 2 diabetes were divided into control and intervention groups. The control group received usual nursing care, and those in the intervention group received usual care and telecoaching for 24 weeks.

FINDINGS:

The intervention group improved: measurements of abdominal circumference, systolic and diastolic blood pressure and body mass index; variables related to glycaemic control (fasting venous glucose and glycated haemoglobin/HbA1c); and high-density lipoprotein levels.

CONCLUSION:

The data indicate that telecoaching is an effective tool for diabetes management. It is recommended that the study should be developed to include more people and run over the long term.