Patient-centeredness and quality management in Dutch diabetes care organizations after a 1-year intervention

Figures & data

Table 1 Change in level of patients’ access to their own medical file per organization (percentages)

How does the patient have access to his medical data?		Care groups (n =51)		Outpatient clinics (n =28)
		Baseline	After intervention	Baseline	After intervention
Level 1	If explicitly asked, a patient has access to his medical record	44.2	24.4	57.1	53.6
Level 2	Access to medical record is under development	30.7	31.7	10.7	21.4
Level 3	The patient can access medical data by use of a diabetes passport	9.0	14.7	21.4	10.7
Level 4	The patient can view his medical record in a patient portal	17.0	29.2	10.7	14.3
P-valuea			0.02*		0.86
Can a patient add data to his medical record?
Level 1	There is no electronic medical record to add data	16.7	11.8	12.5	10.7
Level 2	There is an electronic medical record, but patients cannot add any data	35.3	42.2	66.1	75.0
Level 3	Patients’ access for adding data is under development	34.3	23.5	17.9	7.1
Level 4	Patients can add data to their medical file	13.7	22.5	3.6	7.1
P-value			0.38*		1.00*

Notes:

a Test of change between the scores on a question on patient-centeredness before and after the intervention tested with the related samples Wilcoxon signed rank t-test.

* Indicates significant.

Table 2 Organizations and their safeguarding of patients’ interests, before and after the intervention (percentages)

Subquestion	Care groups (n=51)				Outpatient clinics (n =28)
	No	Under development	Yes	P-valuea	No	Under development	Yes	Do not know	P-valuea
Is there a protocol that informs patients on guidelines?				0.46					0.57
Before	48.0	13.7	38.2		48.2	10.7	33.9	7.1
After	41.2	17.6	41.2		57.1	10.7	28.6	3.6
Is there a front-office or central phone number where patients can ask all questions?				0.01					0.52
Before	58.8	5.9	35.2		3.6	3.6	92.9	0.0
After	42.2	5.9	52.0		3.6	3.6	89.3	3.6
Are the appointment times of several care providers aligned?				0.59					0.41
Before	83.3	6.9	9.8		8.9	7.1	80.4	3.6
After	80.4	4.9	14.7		8.9	10.7	80.4	0.0
Do patients have a case manager?				0.07					0.32
Before	39.2	3.9	56.9		5.4	10.7	83.9	0.0
After	24.5	5.9	69.6		12.5	3.6	83.9	0.0
Is the patients’ privacy guaranteed in the multidisciplinary record?				0.24					1.00
Before	11.8	13.7	74.5		0.0	3.6	89.3	7.1
After	3.9	17.6	78.4		10.7	3.6	78.6	7.1
Is the patients’ privacy assured when gatheringinformation for feedback or benchmark?				0.66					1.00
Before	0.0	2.0	98.0		0.0	0.0	87.5	12.5
After	2.0	0.0	98.0		0.0	3.6	87.5	8.9

Note:

a Test of change between the scores on a question on patient-centeredness before and after the intervention tested with the related samples Wilcoxon signed rank t-test.

Table 3 Patient involvement before and after the intervention (percentages)

How are patients involved in the organization?	Care groups (n =51)			Outpatient clinics (n =28)
	Baseline	After intervention	P-valuea	Baseline	After intervention	P-valuea
They are not involved in the organization	20.6	15.7	0.51	21.4	17.9	1.00
They are not structurally involved in the organization; this is in preparation	23.5	21.6	1.00	14.3	14.3	1.00
In a clients’ board at organizational level	16.7	22.5	0.38	26.8	32.1	1.00
In a special commission handling complaints of patients	14.7	26.5	0.15	21.4	25.0	1.00
In a structural collaboration with a regional patient federation	13.7	20.6	0.34	8.9	17.9	0.69
In a structural collaboration with the Dutch organization for patients with diabetes (DVN)	25.5	23.5	1.00	53.6	46.4	0.52

Notes: Multiple answers are possible.

a Test of change between questions on patient-centeredness before and after the intervention tested with the McNemar test.

Table 4 Weighing of the importance of subdomains within the domain patient-centeredness by two expert panels

Subdomains	Care groups		Outpatient clinics
	Mean (%)	P-valuea	Mean (%)	P-valuea
Self-management support	20.2	NS	31.1	0.04
Individual care plan support	18.7	NS	12.3	0.03
Policy on patient education	12.2	0.02	17.3	NS
Access to medical files	13.7	NS	11.8	0.00
Safeguarding patients’ interests	16.2	NS	12.9	NS
Formal patient involvement	19.2	NS	14.6	NS
Patient-centeredness	100.0		100.0

Notes:

a Significant difference versus equally (each subdomain 16.6%) weighting. Total score which is a weighted average is given in italics.

Abbreviation: NS, not significant.

Figure 1 Flowchart of inclusion and intervention in care groups and outpatient clinics.

Note: The number of outpatient clinics are represented within parentheses.

Table 5 Quality management scores regarding patient-centeredness and its subdomains, at baseline and after the intervention (percentages)

Domains and subdomains	Baseline		After intervention		Change		P-value
	Mean (%)	SD (%)	Mean (%)	SD (%)	Mean (%)	SD (%)
Care groups (n=51)
Self-management support	69.1	34.7	76.7	34.6	7.6	37.9	0.16
Individual care plan support	39.9	24.5	46.4	18.9	6.5	27.1	0.09
Policy on patient education	56.9	27.9	58.6	30.3	1.7	32.6	0.71
Access to medical files	42.0	29.2	49.4	30.7	7.4	25.4	0.04
Safeguarding patients’ interests	58.1	19.7	66.2	17.3	8.1	18.4	0.003
Formal patient involvement	18.2	17.9	23.1	21.3	4.9	19.4	0.08
Patient-centeredness	47.1	16.2	53.3	15.2	6.2	13.6	0.002
Outpatient clinics (n=28)
Self-management support	89.7	21.3	82.1	27.1	−7.6	27.9	0.16
Individual care plan support	53.0	32.4	53.6	27.7	0.6	32.2	0.92
Policy on patient education	78.0	24.9	84.5	19.2	6.6	25.0	0.18
Access to medical files	33.0	25.9	32.7	23.8	−0.3	20.1	0.94
Safeguarding patients’ interests	80.5	16.4	77.7	20.7	−2.8	18.5	0.43
Formal patient involvement	31.0	27.3	33.9	31.7	2.9	38.0	0.69
Patient-centeredness	66.7	14.2	65.6	16.5	−1.1	9.7	0.54

Note: Total score which is a weighted average is given in italics.

Abbreviation: SD, standard deviation.