Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Lee, James D.; Saravanan, Ponnusamy; Varadhan, Lakshminarayanan; Morrissey, John R.; Patel, Vinod (2014)
Publisher: Biomed Central
Journal: BMC Health Services Research
Languages: English
Types: Article
Subjects: RC, Research Article, Health Policy, Alphabet strategy, Diabetes mellitus, Checklist, Chronic disease management, Quality of care, Multifactorial intervention
Background The Alphabet Strategy (AS) is a diabetes care checklist ensuring “important, simple things are done right all the time.” Current audits of diabetes care in developed countries reveal wide variations in quality with performance of care processes frequently sub-optimal. This study had three components: an audit to assess diabetes care quality worldwide,a questionnaire study seeking opinions on the merits of the AS,a pilot study to assess the practicality of implementation of the AS in a low socioeconomic setting. Methods Audit data was collected from 52 centres across 32 countries. Data from 4537 patients were converted to Quality and Outcome Framework (QOF) scores to enable inter-centre comparison. These were compared to each country’s Gross Domestic Product (GDP), and Total Health Expenditure percentage per capita (THE%). The opinions of diabetes patients and healthcare professionals from the diabetes care team at each of these centres were sought through a structured questionnaire. A retrospective audit on 100 randomly selected case notes was conducted prior to AS implementation in a diabetes outpatient clinic in India, followed by a prospective audit after four months to assess its impact on care quality. Results QOF scores showed wide variation across the centres (mean 49.0, range 10.2–90.1). Although there was a positive relationship between GDP and THE% to QOF scores, there were exceptions. 91% of healthcare professionals felt the AS approach was practical. Patients found the checklist to be a useful education tool. Significant improvements in several aspects of care as well as 36% improvement in QOF score were seen following implementation. Conclusions International centres observed large variations in care quality, with standards frequently sub-optimal. 71% of health care professionals would consider adopting the AS in their daily practice. Implementation in a low resource country resulted in significant improvements in some aspects of diabetes care. The AS checklist for diabetes care is a freely available in the public domain encompassing patient education, care plans, and educational resources for healthcare professionals including summary guidelines. The AS may provide a unique approach in delivering high quality diabetes care in countries with limited resources. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-467) contains supplementary material, which is available to authorized users.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. International Diabetes Federation: IDF Diabetes Atlas. 6th edition. Brussels, Belgium: International Diabetes Federation; 2013. http://www.idf.org/ diabetesatlas.
    • 2. American Diabetes Association: Standards of medical care in diabetes - 2014. Diabetes Care 2014, 37:S14-S80.
    • 3. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW: Achievement of goals in US diabetes care, 1999-2010. N Engl J Med 2013, 368:1613-1624.
    • 4. Stone MA, Charpentier G, Doggen K, Kuss O, Lindblad U, Kellner C, Nolan J, Pazderska A, Rutten G, Trento M, Khunti K: Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline adherence to enhance care (GUIDANCE) study. Diabetes Care 2013, 36(9):2628-2638.
    • 5. National Diabetes Audit 2011-2012: Report 1: Care Processes and Treatment Targets. www.hqip.org.uk/asset/NCAPOP-Library/NCAPOP-2013- 14/NDA-2011-2012-CareProcessesTreatmentTargets.pdf.
    • 6. Gaede P, Pedersen O: Intensive integrated therapy of type 2 diabetes - implications for long-term prognosis. Diabetes 2004, 53(suppl 3):S39-S47.
    • 7. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infection in the ICU. N Engl J Med 2006, 355(26):2725-2732.
    • 8. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MCM, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA: A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009, 360:491-499.
    • 9. Bosk CL, Dixon-Woods M, Goeschel CA, Pronovost PJ: Reality check for checklists. Lancet 2009, 374:444-445.
    • 10. Patel V, Morrissey JR: The alphabet strategy: the ABC of reducing diabetes complications. Br J Diabetes Vasc Dis 2002, 2:58-59.
    • 11. Department of Health: Coronary Heart Disease: National Service Framework for Coronary Heart Disease. London: Department of Health; 2000.
    • 12. Lee JD, Morrissey JR, Patel V: Recalculation of cardiovascular risk score as a surrogate marker of change in clinical care of diabetes patients: the alphabet POEM project (Practice Of Evidence-based Medicine). Curr Med Res Opin 2004, 20:765-772.
    • 13. Jaiveer P, Jaiveer S, Jujjavarapu S, Morrissey J, White J, Gadsby R, Patel V: Improvements in clinical diabetes care in the first year of the new general medical services contract in the UK. Br J Diabetes Vasc Dis 2006, 6:45-48.
    • 14. Jaiveer P, Jaiveer S, Lee JD, Morrissey J, Patel V: The alphabet strategy: a tool to achieve clinical trial standards in routine practice? Br J Diabetes Vasc Dis 2003, 3:410-413.
    • 15. Annex A: The New GMS Contract 2003 - Investing in General Practice. Available to download at http://www.nhsemployers.org/your-workforce/ primary-carecontacts/general-medical-services/gms-contract-changes.
    • 16. Varadhan L, Palanikumaran V, Gopinath A, Morrissey J, Patel V: Alphabet strategy - Indian application for diabetes (ASIAD project): a European strategy applied in outpatient setting in Asia. Diabet Med 2006, 23(suppl 2):P294.
    • 17. Grant P: Management of diabetes in resource-poor settings. Clin Med 2013, 13:27-31.
    • 18. Treadwell JR, Lucas S, Tsou AY: Surgical checklists: a systematic review of impacts and implementation. BMJ Qual Saf 2014, 23:299-318.
    • 19. Vats A, Vincent CA, Nagpal K, Davis RW, Darzi A, Moorthy K: Practical challenges of introducing WHO surgical checklist: UK pilot experience. BMJ 2010, 340:133-135.
    • 20. The Alphabet Strategy for Diabetes Care: Delivering NICE Guidance and the POETIC Vision. Available at http://www.nice.org.uk/localPractice/collection#/ localPractice/collection?page=32&pageSize=10&type=&published=&filter=.
    • 21. Gaede P, Lund-Anderson H, Parving H-H, Pedersen O: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008, 358:580-591.
    • 22. International Diabetes Federation Clinical Guidelines Task Force: Global guideline for type 2 diabetes: recommendations for standard, comprehensive and minimal care. Diabet Med 2006, 23:579-593.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article