Background: More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined by the quality of interactions between patients and clinicians at the practice level, it should be facilitated at organizational level too. This nationwide study aimed to assess the state of diabetes quality management on patient-centeredness at organizational level and its possibilities to improve after a tailored intervention. Methods: This before–after study compares the quality management on patient-centeredness within Dutch diabetes care groups and outpatient clinics before and after a 1-year stepwise intervention. At baseline, managers of 51 diabetes primary care groups and 28 outpatient diabetes clinics completed a questionnaire about the organization’s quality management program. Patient-centeredness (0%–100%) was operationalized in six subdomains: facilitating self-management support, individualized care plan support, patients’ access to medical files, patient education policy, safeguarding patients’ interests, and formal patient involvement. The intervention consisted of feedback and benchmark and if requested a telephone call and/or a consultancy visit. After 1 year, the managers completed the questionnaire again. The 1-year changes were examined by dependent (non) parametric tests. Results: Care groups improved significantly on patient-centeredness (from 47.1% to 53.3%; P =0.002), and on its subdomains “access to medical files” (from 42.0% to 49.4%), and “safeguarding patients’ interests” (from 58.1% to 66.2%). Outpatient clinics, which scored higher at baseline (66.7%) than care groups, did not improve on patient-centeredness (65.6%: P =0.54) or its subdomains. “Formal patient involvement” remained low in both care groups (23.2%) and outpatient clinics (33.9%). Conclusion: After a simple intervention, care groups significantly improved their quality management on patient-centeredness, but outpatient clinics did not. Interventions to improve quality management on patient-centeredness in diabetes care organizations should differ between primary and secondary care.
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机译：背景：2型糖尿病患者在护理中更加注重以患者为中心，要求初级保健组和门诊诊所的管理人员越来越重视以患者为中心的糖尿病质量管理流程。尽管以患者为中心的护理最终取决于实践水平上患者与临床医生之间的互动质量，但也应该在组织层次上促进这种护理。这项全国性的研究旨在评估以组织为中心的以患者为中心的糖尿病质量管理状况，以及在进行量身定制的干预措施后其改善的可能性。方法：这项前后研究比较了一年期逐步干预前后荷兰糖尿病护理组和门诊诊所对以患者为中心的质量管理。基线时，有51个糖尿病初级保健小组和28个门诊糖尿病门诊的经理填写了有关该组织质量管理计划的问卷。以患者为中心（0％–100％）在六个子领域中得以实现：促进自我管理支持，个性化护理计划支持，患者获得医疗档案，患者教育政策，维护患者利益和正式患者参与。干预措施包括反馈和基准测试，如果需要，可以进行电话和/或咨询访问。一年后，经理们再次填写了问卷。通过相关（非）参数测试检查了1年的变化。结果：护理组在以患者为中心（从47.1％到53.3％; P = 0.002）以及其子域“获得医疗档案”（从42.0％到49.4％）以及“维护患者利益”方面有了显着改善（ （从58.1％降至66.2％）。门诊诊所在基线时的得分（66.7％）高于护理组，但在以患者为中心（65.6％：P = 0.54）或其子域方面并没有改善。护理组（23.2％）和门诊（33.9％）的“正式患者参与度”仍然很低。结论：经过简单的干预，护理组显着改善了以患者为中心的质量管理，但门诊却没有。在初级保健和二级保健中，在糖尿病患者护理组织中以患者为中心改善质量管理的干预措施应有所不同。
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