Evaluating the Quality of Comprehensive Cardiometabolic Care for Patients With Type 2 Diabetes in the U.S.: The Diabetes Collaborative Registry

The prevalence of diabetes continues to escalate (1,2) with profound impact on complications and mortality (3–5). Evidence-based guidelines (6–9) and performance measures have been developed (10–12). However, there is currently no sustainable nationwide mechanism by which to 1 ) systematically evaluate and track the quality of care in primary and specialty settings or 2 ) evaluate the real-world treatment strategies and their effects on health outcomes. Over the past two decades, quality-oriented registries in cardiovascular disease have pioneered mechanisms of quality assessment, benchmarking, and feedback to individual providers and institutions, and there is evidence that such initiatives can translate into improved quality of care and patient outcomes (13–17). In an effort to extend these efforts to diabetes and cardiometabolic care, the Diabetes Collaborative Registry (DCR) was formed in 2014 by the American College of Cardiology, the American Diabetes Association, the American College of Physicians, the American Association of Clinical Endocrinologists, and the Joslin Diabetes Center. The DCR is a real-world, quality-oriented registry covering the spectrum from primary to specialty outpatient care in the U.S., thereby permitting evaluations of multidisciplinary diabetes care across the spectrum of the disease process (from diagnosis to complications) and the relationship between treatment patterns and health outcomes. Despite evidence-based guidelines for treating patients with diabetes (1,7,9,18,19), a divide exists between the recommendations and their practical application (20). The DCR seeks to fill this void through collecting data on a national level, allowing for regular feedback and benchmarking that we envision will result in rapid-cycle quality improvement efforts. Through measuring adherence to clinical guidelines, quantifying local performance, and reporting these …