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Continued improvement of metabolic control in Swedish pediatric diabetes care.
Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Sweden.
Vise andre og tillknytning
2018 (engelsk)Inngår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, nr 1, s. 150-157Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams.

METHODS: We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes.

RESULTS: The proportion of patients in IQ-1 with a mean HbA1c <7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P < .001), and from 30.2% to 37.2% (P < .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P < .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (>8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group.

CONCLUSIONS: The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2018. Vol. 19, nr 1, s. 150-157
Emneord [en]
diabetes mellitus type 1, hemoglobin A1c protein, human, pediatrics, quality of health care
HSV kategori
Identifikatorer
URN: urn:nbn:se:hj:diva-38825DOI: 10.1111/pedi.12467ISI: 000423397600021PubMedID: 27807917Scopus ID: 2-s2.0-84996848900OAI: oai:DiVA.org:hj-38825DiVA, id: diva2:1182391
Tilgjengelig fra: 2018-02-13 Laget: 2018-02-13 Sist oppdatert: 2018-08-30bibliografisk kontrollert

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