Trends over 8 years in quality of diabetes care: results of the AMD Annals continuous quality improvement initiative

Acta Diabetol. 2015 Jun;52(3):557-71. doi: 10.1007/s00592-014-0688-6. Epub 2014 Dec 21.


Objective: Quality of care monitoring is a key strategy for health policy. In Italy, the AMD Annals continuous monitoring and quality improvement initiative has been in place since 2006. Results after 8 years are now available.

Research design and methods: Quality of diabetes care indicators during the years 2004-2011 were extracted from electronic medical records of 300 diabetes clinics. From 200,000 to 500,000 patients with type 2 diabetes were analyzed per year. Six process indicators, eight intermediate outcome indicators, seven indicators of treatment intensity/appropriateness, and a quality of care summary score (Q score) were evaluated. Previous studies documented that the risk of developing a new cardiovascular event was 80 % higher in patients with a Q score <15 and 20 % higher in those with a score between 15 and 25, as compared to those with a score >25.

Results: The proportion of patients with HbA1c ≤7 %, LDL cholesterol <100 mg/dl, and blood pressure ≥140/90 mmHg increased by 4.8, 21.9, and 10.0 %, respectively. Process and treatment intensity/appropriateness indicators consistently improved. The proportion of patients with a Q score <15 decreased from 13.5 to 6.5 %, while those with a Q score >25 increased from 22.9 to 38.5 %.

Conclusions: AMD Annals document the progress in quality of diabetes care. Longitudinal improvements in Q score can translate into less cardiovascular events, with evident clinical and economic implications. AMD Annals represent a physician-led effort not requiring allocation of extra-economic resources, which is easy to implement and deeply rooted in routine clinical practice. They are a potential case model for other healthcare systems.

MeSH terms

  • Aged
  • Blood Pressure
  • Cholesterol, LDL / metabolism
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Patient Care / standards*
  • Quality Improvement / organization & administration
  • Quality Improvement / standards*
  • Quality of Health Care / organization & administration
  • Quality of Health Care / standards


  • Cholesterol, LDL
  • Glycated Hemoglobin A