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Improving quality of care for persons with diabetes: an overview of systematic reviews - what does the evidence tell us?
Open accessAbstract
Background: Ensuring high quality care for persons with diabetes remains a challenge for healthcare systems globally with consistent evidence of suboptimal care and outcomes. There is increasing interest in quality improvement strategies to improve diabetes management as reflected by a growing number of systematic reviews. These reviews are of varying quality and dispersed across many sources. In this paper, we present an overview of systematic reviews evaluating the impact of interventions to improve the quality of diabetes care. Methods: We searched for systematic reviews evaluating the effectiveness of any intervention intended to improve intermediate patient outcomes and process of care measures for patients with any type of diabetes. Two reviewers independently screened search results, appraised each systematic review using AMSTAR and extracted data from high quality reviews (AMSTAR score ≥ 5). Within reviews, we used vote counting by direction of effect to report the number of studies favouring an intervention for each outcome. We produced summaries of results for each intervention category. Results: We identified 125 reviews of varying methodological quality and summarised key findings from 50 high quality reviews. We categorised reviews by quality improvement intervention. Eight reviews were broad based (involving a variety of strategies). Other reviews considered: patient education and support (n = 21), telemedicine (n = 10), provider role changes (n = 7), and organisational changes (n = 4). Reviews reported intermediate patient outcomes (e.g. glycaemic control) (n = 49) and process of care outcomes (n = 9). There was evidence of considerable overlap of included studies between reviews. Conclusions: There is consistent evidence from high quality systematic reviews that patient education and support, provider role changes, and telemedicine are associated with improvements in glycaemic and vascular risk factor control in patients. There is less evidence about the impact of quality improvement interventions on other key process measures such as screening patients for diabetic complications. This paper provides decision makers with a comprehensive overview of evidence from high quality systematic reviews about the effects of quality improvement interventions on improving diabetes care.
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“Overviews of systematic reviews are an efficient way to gather and summarize in a single source the best available evidence on the effectiveness of interventions.”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [10]
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Metadata
- Authors
- Worswick, J., Wayne, S. C., Bennett, R., Fiander, M., Mayhew, A., Weir, M. C., Sullivan, K. J., & Grimshaw, J. M.
- Affiliations
- Ottawa Hospital (CA)
- University of Ottawa (CA)
- Corresponding author
- Grimshaw, Jeremy M
- Venue
- Systematic Reviews
- Published
- 2013-05-07
- Volume
- 2
- Issue
- 1
- Pages
- 26-26
- ISSN
- 2046-4053 (ISSN-L)
- PMC
- PMC3667096
- OpenAlex
- W2105352120
- Cited by
- 130
- References
- 92
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 13 · 2021: 6 · 2020: 14 · 2019: 14 · 2018: 16 · 2017: 9 · 2016: 21 · 2015: 10 · 2014: 7 · 2013: 1
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Systematic Reviews (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- diabetes care quality, quality improvement intervention, telemedicine, organizational change, glycemic control, vascular risk factor control, process of care
- MeSH terms
- Delivery of Health Care, Diabetes Mellitus, Humans, Patient Education as Topic, Telemedicine, Professional Role, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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