Missed Opportunities in Diabetes Management: A Longitudinal Assessment of Factors Associated with Sub-optimal Quality
Missed Opportunities in Diabetes Management: A Longitudinal Assessment of Factors Associated with Sub-optimal Quality
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DOI：
10.1007/s11606-008-0757-z
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发表时间：
2008-11-01
影响因子：
5.7
通讯作者：
Brancati, Frederick L.
中科院分区：
文献类型：
--
作者：
Samuels, T. Alafia;Bolen, Shari;Brancati, Frederick L.
背景技术背景：在成人糖尿病患者中，严格控制危险因素可减少并发症。目的：确定未能进行访视、监测危险因素或强化治疗是否会影响血压、血糖和血脂的控制。设计：一项非同期前瞻性研究，数据来自1999年1月1日至2001年12月31日期间的电子文件和硬拷贝病历的标准化摘要。参与者：383名成人糖尿病患者在一个学术附属的管理式护理program.MEASUREMENTS：主要暴露变量：强化治疗或未能强化，按季度计算。主要结果测量：血红蛋白A1 c（A1 c），收缩压（SBP），和LDL-胆固醇在interval.RESULTS结束时：在这个访问坚持队列，控制血糖和血脂显示改善超过24个月，但许多患者没有达到目标。只有那些血压控制最差（SBP >= 160 mmHg）的患者在2年内显示出任何改善。未能加强治疗的患者谁保持访问是单一的最强的预测控制不佳。与没有强化治疗失败的患者相比，≥ 3个乳区失败的患者血糖控制明显较差（A1 c升高1.4%：95% CI：0.7，2.1）;高血压（SBP升高22.2 mmHg：95% CI：16.6，27.9）和LDL胆固醇（LDL升高43.7 mg/dl：95% CI：24.1，63.3）。这些关系是强大的，分级，独立的社会人口因素，基线风险因素值，和co-morbidity.CONCLUSIONS：未能加强治疗导致次优控制，即使有足够的访问和监测。旨在促进适当强化的干预措施应加强初级实践中的糖尿病护理。
BACKGROUND: In diabetic adults, tight control of risk factors reduces complications.OBJECTIVE: To determine whether failure to make visits, monitor risk factors, or intensify therapy affects control of blood pressure, glucose, and lipids.DESIGN: A non-concurrent, prospective study of data from electronic files and standardized abstraction of hard-copy medical records for the period 1/1/1999-12/31/2001.PARTICIPANTS: Three hundred eighty-three adults with diabetes managed in an academically affiliated managed care program.MEASUREMENTS: Main exposure variable: Intensification of therapy or failure to intensify, reckoned on a quarterly basis. Main outcome measure: Hemoglobin A1c (A1c), systolic blood pressure (SBP), and LDL-cholesterol at the end of the interval.RESULTS: In this visit-adherent cohort, control of glycemia and lipids showed improvement over 24 months, but many patients did not achieve targets. Only those with the worst blood pressure control (SBP >= 160 mmHg) showed any improvement over 2 years. Failure to intensify treatment in patients who kept visits was the single strongest predictor of suboptimal control. Compared to their counterparts with no failures of intensification, patients with failures in >= 3 quarters showed markedly worse control of blood glucose (A1c 1.4% higher: 95% CI: 0.7, 2.1); hypertension (SBP 22.2 mmHg higher: 95% CI: 16.6, 27.9) and LDL cholesterol (LDL 43.7 mg/dl higher: 95% CI: 24.1, 63.3). These relationships were strong, graded, and independent of socio-demographic factors, baseline risk factor values, and co-morbidities.CONCLUSIONS: Failure to intensify therapy leads to suboptimal control, even with adequate visits and monitoring. Interventions designed to promote appropriate intensification should enhance diabetes care in primary practice.