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In anticipation of patient participation.

and microvascular complications and mortality (Steno-2) [3]. It is therefore crucial to assess these parameters when attempting to measure quality of care rather than processes of care, such as the rate of retinal screening, foot examinations and measurement of HbA1c. Mangione and collaborators [4] conducted a large cross-sectional study, sampling patients from several HMOs. Intensity of disease management was determined through surveys, and diabetes care processes and control of intermediate outcomes were assessed. Interestingly, a higher intensity of management was associated with a higher rate of care processes but not with intermediate outcome levels. Although this study has several limitations, it stresses the need to carefully follow both care processes and therapy goals to ensure effectiveness. Diabetes quality measures might be divided into accountability measures (HbA1c, LDL and BP) and improvement measures, focusing on processes of care [5]. Many strategies may be developed to improve disease management. These include educational or learning interventions (both for the patient and the physician), patient activation, as well as electronic medical records. The Minnesota Department of Health initiated a large health project to train primary care clinic personnel in a seven-step quality improvement method. The quality improvement change process was successfully implemented, but it failed to improve HbA1c, LDL or BP levels [6].