Sammanfattning
Objective. Randomized trials showed that changes in healthcare organization improved diabetes
care. This study aimed to identify which organizational determinants were associated with patient
outcomes in routine diabetes care. Design. Observational study, in which multilevel regression
analyses were applied to examine the impact of 12 organizational determinants on diabetes care as
separate measures and as a composite score. Setting. Primary care practices in the Netherlands.
Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients’ recorded
glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A
higher score on the composite measure of organizational determinants was associated with better
control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found.
Exploration of specific organizational factors found significant impact of use of an electronic patient
registry on HbA1c (OR = 1.80, 95% CI 1.12-2.88), availability of patient leaflets on systolic blood
pressure control (OR = 2.59, 95% CI 1.06-6.35), and number of hours’ nurse education on cholesterol
control (OR = 2.51, 95% CI 1.02-6.15). Conclusion. In routine primary care, it was found that favorable
healthcare organization was associated with a number of intermediate outcomes in diabetes care.
This finding lends support to the findings of trials on organizational changes in diabetes care.
Notably, the composite measure of organizational determinants had most impact.