Evaluation of Diabetic Clinic Total Quality Improvement Project in Thalang Health Care Network, Thalang, Phuket 2009

Abstract

          It is very important that every diabetic patient receives quality care. But, the recent evaluation in Thalang’s diabetic care, reported that most of the diabetic cases neither received the same quality of care nor received the diabetic complications screening. In 2009, Thalang health care network started total quality improvement of diabetic care project. The objective of this research was to evaluate the outcome of this project. The study used CIPP Model to study 10 diabetic clinics by purposive sampling. The data collection methods were focus group interview, questionnaire, report forms and patient’s record. The data collection was done in September 2009. Descriptive analysis and content analysis were carried out afterward. Context; the mean distance from home to diabetics clinics was 2.5 Km. (range 10 meters - 15 Km) Input; each diabetic clinics had one responsible registered nurse as the health care provider. The major proportion of total budget was the medical material cost (33.52%). Process; there were 5 follow up meetings during the project, 2 supervisions, 2 trainings, a revision of medical history record, the development of clinical practice guideline, development of electronic data management, a medical record audit every 3 months, a training of self help group. Product; there were 96.67 percent of the cases matched to referral in criteria. Two diabetic clinics passed all the diabetic care quality assessment criteria. There were 9 diabetic clinics that could meet the standard based on an indicator for diabetic case management (standard indicator HbA1C less than 7 ≥ 40%). But none of them could meet the standard with an indicator for controlling LDL (LDL < 100 mg/dl ≥ 90%). From the self report of diabetic cases; 48.28 percent reported paresthesia, 36.55 percent reported poor vision and 95.17 percent report satisfaction of the whole process of the diabetic care. In conclusion, the total quality improvement of the project could improve the quality of diabetic
care. Anyway, there still some diabetic cases who could not control blood sugar or lipid level. Though, there should be a continuous improvement of the caring system and focus on monitoring the complications especially among the uncontrolled blood sugar and lipid cases.
Key words: diabetic clinic, service quality, network, evaluation, Phuket