ORIGINAL ARTICLE Organizational determinants of high-quality routine diabetes care

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. Obser-vational 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 specifi c organizational factors found signifi cant impact of use of an electronic patient registry on HbA1c (OR 1.80, 95 % CI 1.12 – 2.88), availability of patient leafl ets 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 fi nding lends support to the fi ndings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact