Table 2.
Effects of individual QI strategies by HbA1c, blood pressure, and LDL-C subgroups
| QI strategy | HbA1c (NGSP) |
HbA1c (IFCC) |
||||||
|---|---|---|---|---|---|---|---|---|
| ≥8% |
<8% |
≥64 mmol/mol |
<64 mmol/mol |
|||||
| N | MD (95% CI) | N | MD (95% CI) | N | MD (95% CI) | N | MD (95% CI) | |
| Health system | ||||||||
| Case management |
23 |
−0.40 (−0.54 to −0.26) |
21 |
−0.08 (−0.13 to −0.03) |
23 |
−4.4 (−5.9 to −2.8) |
21 |
−0.9 (−1.4 to −0.3) |
| Team change |
24 |
−0.46 (−0.63 to −0.29) |
20 |
−0.37 (−0.59 to −0.15) |
24 |
−5.0 (−6.9 to −3.2) |
20 |
−4.0 (−6.4 to −1.6) |
| Electronic patient registry |
2 |
−0.43 (−0.68 to −0.19) |
5 |
−0.07 (−0.13 to −0.02) |
2 |
−4.7 (−7.4 to −2.1) |
5 |
−0.8 (−1.4 to −0.2) |
| Facilitated relay |
23 |
−0.36 (−0.53 to −0.20) |
13 |
−0.12 (−0.18 to −0.06) |
23 |
−3.9 (−5.8 to −2.2) |
13 |
−1.3 (−2.0 to −0.7) |
| E-health |
17 |
−0.29 (−0.41 to −0.17) |
12 |
−0.06 (−0.12 to 0.00) |
17 |
−3.2 (−4.5 to −1.9) |
12 |
−0.7 (−1.3 to 0.0) |
| Continuous QI |
10 |
−0.36 (−0.56 to −0.15) |
5 |
−0.09 (−0.14 to −0.03) |
10 |
−3.9 (−6.1 to −1.6) |
5 |
−1.0 (−1.5 to −0.3) |
| HCPs | ||||||||
| Audit and feedback |
4 |
−0.50 (−0.51 to −0.49) |
10 |
−0.04 (−0.10 to 0.02) |
4 |
−5.5 (−5.6 to −5.4) |
10 |
−0.4 (−1.1 to −0.2) |
| Clinician education |
6 |
−0.32 (−0.51 to −0.13) |
6 |
−0.15 (−0.28 to −0.02) |
6 |
−3.5 (−5.6 to −1.4) |
6 |
−1.6 (−3.1 to −0.2) |
| Clinician reminder |
22 |
−0.31 (−0.46 to −0.17) |
14 |
−0.07 (−0.14 to 0.00) |
22 |
−3.4 (−5.0 to −1.9) |
14 |
−0.8 (−1.5 to 0.0) |
| Patients | ||||||||
| Patient education |
16 |
−0.46 (−0.60 to −0.32) |
13 |
−0.12 (−0.18 to −0.07) |
16 |
−5.0 (−6.6 to −3.5) |
13 |
−1.3 (−2.0 to −0.8) |
| Promotion of self-management |
32 |
−0.39 (−0.51 to −0.26) |
20 |
−0.22 (−0.39 to −0.05) |
32 |
−4.3 (−5.6 to −2.8) |
20 |
−2.4 (−4.3 to −0.5) |
| Patient reminder system |
29 |
−0.36 (−0.50 to −0.22) |
16 |
−0.08 (−0.14 to −0.02) |
29 |
−3.9 (−5.5 to −2.4) |
16 |
−0.9 (−1.5 to −0.2) |
| SBP |
DBP |
|||||||
| ≥140 mmHg |
<140 mmHg |
≥80 mmHg |
<80 mmHg |
|||||
|
N |
MD (95% CI) |
N |
MD (95% CI) |
N |
MD (95% CI) |
N |
MD (95% CI) |
|
| Health system | ||||||||
| Case management |
14 |
−2.7 (−4.6 to −0.8) |
15 |
−2.9 (−4.7 to −1.0) |
15 |
−1.3 (−2.4 to −0.1) |
12 |
−1.6 (−2.6 to −0.7) |
| Team change |
14 |
−5.2 (−7.3 to −3.0) |
14 |
−2.3 (−3.6 to −1.0) |
23 |
−1.5 (−2.5 to −0.6) |
7 |
−1.1 (−1.3 to −1.0) |
| Electronic patient registry |
3 |
−4.9 (−7.6 to −2.2) |
4 |
−4.0 (−7.6 to −0.4) |
5 |
−3.3 (−5.0 to −1.6) |
3 |
−1.9 (−5.8 to 2.1) |
| Facilitated relay |
12 |
−4.4 (−7.1 to −1.8) |
15 |
−2.7 (−4.4 to −1.0) |
11 |
−1.6 (−3.1 to 0.0) |
10 |
−1.5 (−2.2 to −0.9) |
| E-health |
9 |
−2.6 (−5.0 to −0.2) |
10 |
−2.0 (−4.4 to 0.4) |
10 |
−1.7 (−3.3 to 0.0) |
8 |
−1.6 (−2.9 to −0.2) |
| Continuous QI |
6 |
−4.7 (−7.2 to −2.2) |
7 |
−1.1 (−2.8 to 0.6) |
5 |
−1.7 (−3.9 to 0.5) |
5 |
−0.9 (−2.2 to 0.5) |
| HCPs | ||||||||
| Audit and feedback |
9 |
−3.2 (−6.5 to 0.0) |
2 |
−2.9 (−7.0 to 1.3) |
6 |
−1.9 (−4.2 to 0.3) |
6 |
−1.3 (−1.8 to −0.7) |
| Clinician education |
5 |
−2.5 (−8.0 to 3.1) |
2 |
−4.5 (−7.4 to −1.5) |
6 |
−0.9 (−2.9 to 1.2) |
2 |
−1.2 (−2.8 to 0.4) |
| Clinician reminder |
12 |
−2.8 (−5.4 to −0.3) |
9 |
−4.3 (−6.5 to −2.0) |
15 |
−0.7 (−1.9 to 0.4) |
8 |
−1.4 (−3.0 to 0.1) |
| Patients | ||||||||
| Patient education |
15 |
−5.1 (−7.3 to −3.0) |
8 |
−2.9 (−5.9 to 0.1) |
17 |
−1.8 (−2.9 to −0.8) |
5 |
−2.8 (−4.6 to −0.9) |
| Promotion of self-management |
18 |
−4.7 (−6.7 to −2.7) |
20 |
−2.4 (−3.9 to −0.9) |
23 |
−1.7 (−2.6 to −0.8) |
13 |
−1.5 (−2.0 to −1.0) |
| Patient reminder system |
14 |
−3.2 (−5.6 to −0.8) |
11 |
−2.9 (−4.8 to −1.0) |
16 |
−1.5 (−2.8 to −0.3) |
9 |
−1.3 (−1.8 to −0.9) |
| LDL-C* |
||||||||
| ≥3.4 mmol/L |
<3.4 mmol/L |
|||||||
|
N |
MD (95% CI) |
N |
MD (95% CI) |
|||||
| Health system |
||||||||
| Case management |
2 |
−0.20 (−0.27 to −0.14) |
21 |
−0.07 (−0.14 to 0.00) |
||||
| Team change |
4 |
−0.31 (−0.60 to −0.02) |
18 |
−0.15 (−0.24 to −0.06) |
||||
| Electronic patient registry |
NA |
NA |
3 |
−0.13 (−0.26 to 0.01) |
||||
| Facilitated relay |
4 |
−0.39 (−0.62 to −0.17) |
20 |
−0.12 (−0.19 to −0.04) |
||||
| E-health |
NA |
NA |
16 |
−0.10 (−0.18 to −0.02) |
||||
| Continuous QI |
NA |
NA |
6 |
−0.10 (−0.25 to 0.04) |
||||
| HCPs |
||||||||
| Audit and feedback |
2 |
−0.33 (−0.62 to −0.04) |
6 |
−0.06 (−0.22 to 0.09) |
||||
| Clinician education |
NA |
NA |
5 |
−0.12 (−0.27 to 0.04) |
||||
| Clinician reminder |
NA |
NA |
17 |
−0.08 (−0.16 to 0.00) |
||||
| Patients |
||||||||
| Patient education |
4 |
−0.23 (−0.48 to 0.01) |
10 |
−0.11 (−0.21 to −0.02) |
||||
| Promotion of self-management |
4 |
−0.23 (−0.48 to 0.01) |
23 |
−0.13 (−0.20 to −0.06) |
||||
| Patient reminder system | 4 | −0.31 (−0.60 to −0.02) | 16 | −0.06 (−0.14 to 0.01) | ||||
IFCC, International Federation of Clinical Chemistry and Laboratory Medicine; MD, mean difference; N, number of trials with analyzable data; NA, no available trials for analysis; NGSP, National Glycohemoglobin Standardization Program.
*To convert LDL-C to mg/dL, multiply by 38.67.