Improving performance in the detection and management of cystic fibrosis-related diabetes in the Mountain West Cystic Fibrosis Consortium.
Improving performance in the detection and management of cystic fibrosis-related diabetes in the Mountain West Cystic Fibrosis Consortium.
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提高西山区囊性纤维化联盟在囊性纤维化相关糖尿病的检测和管理方面的表现。
DOI：
10.1136/bmjdrc-2015-000183
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发表时间：
2016
影响因子：
4.1
通讯作者：
中科院分区：
文献类型：
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作者：
Liou,TheodoreG;Jensen,JudithL;Allen,SarahE;Brayshaw,SaraJ;Brown,MarkA;Chatfield,Barbara;Koenig,Joni;McDonald,Catherine;Packer,KristynA;Peet,Kimberly;Radford,Peggy;Reineke,LindaM;Otsuka,Kim;Wagener,JeffreyS;Young,David;
目的囊性纤维化 (CF) 相关糖尿病 (CFRD) 与发病率和死亡率增加相关。改进检测和管理可以改善结果；然而，实际操作并未达到已发布的指导方针。我们研究了西山 CF 联盟 (MWCFC) 为改善 CFRD 筛查和管理所做的努力。研究设计和方法这是一项前瞻性观察队列研究，评估亚利桑那州、科罗拉多州、新墨西哥州和犹他州经认可的 CF 中心在 2002 年至 2008 年间进行的质量改进情况。在机构审查委员会 (IRB) 批准后，各中心评估了 CFRD CF 基金会指南的遵守情况。每个中心都制定并实施了质量改进计划，以改进筛查和管理。 1 年后对中心进行重新评估。结果最初，每个 CF 中心对筛查建议的遵守率较低（符合条件的患者为 26.5%），并且在研究期间没有改善。然而，确诊的 CFRD 患者显着增加（141 例（MWCFC 患者的 12%）至 224 例（17%），p<0.001），并且随着对管理指南的遵守程度的提高，CFRD 患者的体重（56.8–58.9 kg，p<0.001）、体重指数（21.1–21.4，p=0.003）和年龄别体重 z 评分均有所增加（−1.42 至 –0.84，p<0.001）。质量改进方法针对每个中心的实践环境，但都有遵守 CFRD 护理指南的共同目标。实施 1 年后，没有任何中心在遵守指南的水平上与其他中心有显着差异。 结论 提高 CFRD 护理指南的遵守率需要付出巨大的努力，并且可能不会完全成功，特别是对于 CFRD 筛查，但这种努力可能会显着改善患者监测和体重等临床相关结果。
ObjectiveCystic fibrosis (CF)-related diabetes (CFRD) is associated with increased morbidity and mortality. Improved detection and management may improve outcomes; however, actual practice falls short of published guidelines. We studied efforts to improve CFRD screening and management in the Mountain West CF Consortium (MWCFC).Research design and methodsThis is a prospective observational cohort study evaluating quality improvement by accredited CF centers in Arizona, Colorado, New Mexico, and Utah performed between 2002 and 2008. After Institutional Review Board (IRB) approval, centers evaluated adherence with CF Foundation guidelines for CFRD. Each center developed and implemented quality improvement plans to improve both screening and management. Centers were reassessed 1 year later.ResultsInitially, each CF center had low adherence with screening recommendations (26.5% of eligible patients) that did not improve during the study. However, patients with confirmed CFRD markedly increased (141 (12% of MWCFC patients) to 224 (17%), p<0.001), and with improved adherence to management guidelines, patients with CFRD had increased weight (56.8–58.9 kg, p<0.001), body mass index (21.1–21.4, p=0.003), and weight-for-age z-score (−1.42 to –0.84, p<0.001). Quality improvement methods were specific to the practice settings of each center but shared the common goal of adhering to CFRD care guidelines. 1 year after implementation, no center significantly differed from any other in level of adherence to guidelines.ConclusionsImproving adherence with CFRD care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.