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Table 3 Within-practice comparison of first and second measurement of practices in first cohort and between practice comparison of first and second cohort in 2009-2011

From: Effect of accreditation on the quality of chronic disease management: a comparative observational study

Indicators1 1stcohort Within-group comparison of 1stcohort2 2ndcohort Between-groups comparison 1stand 2ndcohort 2009-20113
2006-2008 2009-2011 2009-2011
Mean (SD) Mean (SD) Estimate (95% conf. int.) p Mean (SD) Estimate (95% conf. int.) p
Diabetes       
Prevalence 0.040 (0.014) 0.050 (0.013) 0.010 (0.006 - 0.015) 0.000 0.051 (0.018) -0.001 (-0.006 - 0.005) 0.79
Outcome measures        
HbA1c < target 60.8 (15.9) 63.6 (11.4) 2.6 (-2.6 - 7.9) 0.32 63.6 (11.0) -0.02 (-4.0 - 3.9) 0.99
Blood pressure < target4 56.6 (16.7) 52.1 (17.0) -5.4 (-11.4 - 0.7) 0.08 50.8 (16.7) 0.9 (-4.9 - 6.7) 0.76
Total cholesterol < target4 50.4 (15.0) 45.2 (20.1) -5.4 (-12.4 - 1.5) 0.12 36.3 (20.7) 8.8 (1.5 - 16.1) 0.02
Process measures        
Mean process score 79.2 (10.0) 81.6 (12.7) 2.3 (-1.5 - 6.1) 0.23 79.5 (12.7) 1.8 (-2.5 - 6.2) 0.41
HbA1c measurement 90.4 (10.2) 92.5 (7.3) 2.1 (-1.1 - 5.4) 0.20 92.4 (6.7) -0.03 (-2.5 - 2.4) 0.98
BP5 measurement 93.7 (7.0) 91.9 (13.3) -1.7 (-5.0 - 1.7) 0.32 92.4 (8.9) -0.7 (-4.7 - 3.3) 0.74
Cholesterol measurement 81.3 (14.4) 86.1 (12.4) 4.8 (0.2 - 9.4) 0.04 86.6 (9.4) -0.6 (-4.4 - 3.2) 0.74
Creatinine clearance 82.1 (13.1) 85.3 (17.0) 3.4 (-1.2 - 7.9) 0.14 83.6 (17.3) 1.2 (-4.8 - 7.2) 0.69
Retinal examination 70.6 (16.4) 66.4 (24.4) -4.5 (-12.0 - 3.1) 0.24 62.3 (26.6) 3.9 (-4.9 - 12.7) 0.39
Feet examination 57.3 (22.7) 67.1 (26.4) 9.7(0.9 - 18.5) 0.03 59.7 (27.1) 7.2 (-2.1 - 16.5) 0.13
Prescription of lipid lowering medication 60.5 (16.4) 69.9 (22.6) 9.5 (2.5 - 16.4) 0.009 68.4 (13.1) 1.1 (-5.1 - 7.4) 0.72
Chronic obstructive pulmonary disease (COPD)      
Prevalence 0.017 (0.009) 0.022 (0.008) 0.005 (0.003 - 0.008) 0.000 0.023 (0.010) -0.001 (-0.004 - 0.003) 0.65
Outcome measure        
Patients that smoke 36.6 (22.9) 31.8 (16.1) -4.9 (-11.5 - 1.8) 0.15 32.2 (20.7) -0.4 (-6.9 - 6.2) 0.92
Process measures        
Mean process score 58.5 (17.8) 67.2 (22.1) 8.3 (1.8 - 14.8) 0.01 61.6 (24.9) 5.5 (-2.8 - 13.8) 0.19
Smoke status known 76.0 (21.4) 75.4 (23.2) -1.3 (-8.1 - 5.6) 0.71 69.4 (27.0) 6.1 (-2.8 - 15.0) 0.18
Spirometry 41.2 (23.5) 58.8 (28.7) 17.0 (8.0 - 26.0) 0.000 53.8 (28.5) 4.7 (-5.5 - 14.8) 0.37
Stop smoking advice 47.0 (33.9) 69.8 (30.8) 21.8 (8.7 - 34.9) 0.002 65.2 (32.6) 5.1 (-10.1 - 20.2) 0.51
Cardiovascular disease (CVD) 6       
Outcome measures        
Patients that smoke - 12.6 (8.5) - - 10.5 (7.8) 1.9 (-1.1 - 4.9) 0.20
Blood pressure < target4 - 41.8 (15.5) - - 35.7 (14.7) 6.3 (0.6 - 11.9) 0.03
Process measures        
Mean process score - 61.3 (20.3) - - 54.5 (21.6) 6.5 (-1.2 - 14.1) 0.10
Smoke status known - 51.7 (26.6) - - 39.8 (25.5) 11.3 (1.9 - 20.8) 0.02
BP5 measurement - 70.8 (17.9) - - 69.3 (21.3) 1.6 (-5.6 - 8.9) 0.66
Stop smoking advice - 66.7 (34.2) - - 51.1 (34.0) 13.2 (-4.6 - 30.9) 0.14
Glucose measurement - 77.5 (17.6) - - 64.3 (24.3) 12.0 (1.9 - 22.0) 0.02
Prescription of anticoagulants - 78.8 (15.0) - - 76.5 (20.4) 1.6 (-5.1 - 8.3) 0.64
  1. 1Except for prevalence values, all values in this table report the percentage of patients treated according to the guidelines/for which the indicator was met (deviations, estimates and 95% confidence intervals are also reported in number of percentage points). 2Results are based on multilevel regression analyses, accounting for repeated measures per practice and correcting for practice size, practice type and practice location. 3Results are based on regression analyses, correcting for practice size, practice type and practice location. 4In prevailing guidelines, target levels on blood pressure and cholesterol were tightened over time. This may partly account for a decrease in these scores regarding diabetes. 5BP = blood pressure. 6The inclusion criteria for patients with risk for cardiovascular disease changed towards the inclusion of patients with known cardiovascular disease only, which made a within-group comparison of the first cohort not justifiable.
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