Objective: The aim of this study was to evaluate whether implementation of an integrated regional program can be effective in producing improvement in diabetes care.
Methods: Friuli Venezia Giulia is an Italian region accounting for about 1,250,000 population. A diabetic patients register based on administrative databases merging accounted in 2015 for a morbidity prevalence rate of 6.7%. Guidelines on diabetes integrated care were approved by the regional government. They were disseminated through a multifaceted intervention based on training, incentives to family physicians, primary care reorganization, modeling and proactive medicine. The program was assessed through the before-after intervention measure of process indicators. Analysis excluded gestational patients, those who didn’t consent for privacy reasons and those not included in the same family physician administrative list over the study period.
Results: Regionally, significant improvement in 2016 vs. 2015 was observed for all measures. Analysis included 54593 patients. The percentage of patients who received one ore more: A1C test arose from 73.8% in 2015 to 79.1% in 2016 (+7.2%), Microalbuminuria test arose from 44.7% in 2015 to 56.3 in 2016 (+26.0%), Blood Creatinine test arose from 70.7% in 2015 to 76.2% in 2016 (+7.8%), Lipid profile arose from 69.6% in 2015 to 72.6% in 2016 (+4.3%). Those who received at least one Fundus Oculi arose from 42.1% in 2014-2015 to 47.9% in 2015-2016 (+13.8%). Hospital specific diabetes patients admission rate decreased from 342/1000 in 2015 to 328/1000 in 2016 (-4.2%). However, there was significant regional variation among all measures.
Conclusions: The evidence based introduction of an integrated professional and organizational intervention improved adherence to diabetes specific process measures in 2016 compared with 2015 baseline for patients assisted in Friuli Venezia Giulia region. A better integration with hospital care and a partial revision of IT system are needed.
A. Mariotto: None. A. De Monte: None.