Effects of quality improvement strategies for type 2 diabetes in Bronx, N.Y.

Periodic appraisal of the QI plan is a key component of the evolution of the integrated delivery system's organization. It is based on achievement of, or progress toward, key quality and performance objectives and evidence that performance improvement methodologies are being used effectively day to day. Data collection can be performed through abstracting of paper medical records, completing paper flow sheets prospectively, or using electronic data systems. The latter is faster and cost-effective and is the one more frequently used by our QI programs. With this system, it is now possible to monitor and learn the impact and cost of different interventions. Barriers to QI include resistance of personnel to adjust to these new policies in spite of professional education; there is need for constant surveillance of the proposed interventions, and there is inability to retrieve important quality indexes because of poor documentation. Despite the advanced technology available, analyses can be skewed or inaccurate. It is, for instance, difficult to track patient medications, which often change in the course of a hospital stay. Although this is a cross-sectional analysis of all patients, analysis of individual patients may yield different information. One of the new projects based on this data will be to post glycemic quarterly performance data by unit, with the goal of providing a more updated glycemic control profile in each unit and also creating an incentive for competitive practice towards improvement. With enhanced electronic data and continuous improvement of software technology that adapts better to physicians' needs, these QI projects will provide new and superior information to improve patient care.