Evaluation of a new care system provided to diabetic patients in the outpatient clinic

Intern Med. 2000 Oct;39(10):783-7. doi: 10.2169/internalmedicine.39.783.

Abstract

Objective: Evaluation of metabolic states and chronic complications is essential for maintaining a high quality of care for diabetic patients. We have assessed the quality of care in routine outpatient clinics for diabetic subjects in our university hospital, and compared with those in a newly introduced standardized clinic to evaluate the new care system.

Methods: The quality of care was assessed by the chart review in 1995, and compared with those from 1996-1997 in the "Diabetes Follow-up Clinic" which is systematically designed for the standardized care.

Patients: The subjects were recruited among 860 patients who visited the outpatient clinic in July and August of 1995 with a diagnosis of diabetes or glucose intolerance. Six hundred seventy-two patients whose follow-up period had been more than 6 months with clinically diagnosed diabetes were used for the analysis.

Results: Laboratory tests such as determination of HbA1c, and serum levels of lipids and creatinine were performed in more than 90% of the patients in the routine outpatient clinics. However, ophthalmology referral, 24-hour urine collection for the determination of creatinine clearance and albumin excretion, and electrocardiograms were not well performed and were incompletely documented (40-60% of the patients within a previous year and 70-80% in the last 2 years). In the standardized "Diabetes Follow-up Clinic", only four out of 555 diabetic patients failed to collect their 24-hour urine, and all participants had ankle blood pressure measurements, nerve conduction study, and nylon monofilament tests, etc. Furthermore, more than 95% of the patients had funduscopic examinations by ophthalmologists as well as records of electrocardiogram.

Conclusion: Introduction of the standardized "Diabetes Follow-up Clinic" may be one of the choices for increasing the quality of outpatient care and for the prevention of chronic diabetic complications.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Albuminuria / urine
  • Ambulatory Care Facilities / statistics & numerical data*
  • Blood Pressure
  • Creatinine / blood
  • Diabetes Mellitus / metabolism
  • Diabetes Mellitus / prevention & control*
  • Diagnostic Tests, Routine / statistics & numerical data
  • Electrocardiography
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Services / statistics & numerical data*
  • Humans
  • Japan
  • Lipids / blood
  • Male
  • Middle Aged
  • National Health Programs / statistics & numerical data
  • Patient Compliance*
  • Primary Prevention
  • Quality of Health Care*
  • Referral and Consultation / statistics & numerical data

Substances

  • Glycated Hemoglobin A
  • Lipids
  • Creatinine