Measures of disease control in Medicare beneficiaries with diabetes mellitus
Measures of disease control in Medicare beneficiaries with diabetes mellitus
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DOI：
10.1111/j.1532-5415.1999.tb07233.x
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发表时间：
1999-04-01
影响因子：
6.3
通讯作者：
Gohdes, D
中科院分区：
文献类型：
--
作者：
Kell, SH;Drass, J;Gohdes, D
目的：探讨医疗保险受益人糖尿病患者的疾病控制措施及其门诊服务收费环境。设计：回顾性队列研究。背景：在阿拉巴马州、爱荷华州和马里兰州的293名初级保健医生（pcp）的办公室实践，他们自愿参加门诊护理质量改进项目。参与者：共5980例患者，平均年龄75.2岁。测量：在18个月的时间里（1994年1月1日- 1995年6月30日），提取医疗记录的临床参数，包括多达四项血糖值；两次血压测量；一个总胆固醇值；两种血清肌酐值；药物使用，包括抗高血压药、血管紧张素转换酶（ACE）抑制剂和降脂药；糖化血红蛋白（GHb）检测频率。结果：在研究期间，44%的患者接受了至少一次GHb检测，94%接受了至少一次血糖检测，68%接受了至少一次血清总胆固醇检测，74%接受了至少一次血清肌酐检测，97%接受了至少一次血压检测。10%的患者平均血糖水平大于或等于250毫克/分升。85%的人有高血压的迹象。在这组有血压读数的高血压患者中，70%的人的血压读数大于或等于140/90毫米汞柱，即使他们服用了本可以治疗高血压的药物。有高血压迹象的人中有36%服用了ACE抑制剂。32%服用降脂药物的患者血清总胆固醇值大于或等于240毫克/分升。年龄和性别之间存在统计学上的显著差异，男性和85岁以上的患者通常有更好的疾病控制措施。结论：许多老年医保糖尿病患者没有达到推荐的血糖、血压和血脂目标水平。GHb和血清胆固醇没有按照建议的时间间隔进行监测。改善这一人群的糖尿病护理存在重大机遇。
OBJECTIVE: To investigate measures of disease control for Medicare beneficiaries with diabetes and their outpatient care in the fee-for-service setting.DESIGN: Retrospective cohort study.SETTINGS: Office practices in Alabama, Iowa,, and Maryland of 293 primary care physicians (PCPs) who volunteered to participate in the Ambulatory Care Quality Improvement Project.PARTICIPANTS: A total of 5980 patients with an average age of 75.2 years.MEASUREMENTS: For an 18-month period (1/1/94 - 6/30/95), medical records were abstracted for clinical parameters, including up to four blood glucose values; two blood pressure measurements; one total cholesterol value; two serum creatinine values; medication use, including antihypertensives, angiotensin- converting enzyme (ACE) inhibitors, and lipid-lowering agents; and frequency of glycosylated hemoglobin (GHb) determinations. RESULTS: During the study, 44% of patients received at least one GHb determination, 94% received at least one blood glucose, 68% at least one total serum cholesterol, 74% at least one serum creatinine test, and 97% at least one blood pressure measurement. Ten percent of patients had mean blood glucose levels greater than or equal to 250 mg/dL. Eighty-five percent had evidence of hypertension. Of this group of hypertensive patients with blood pressure readings available, 70% had blood pressure readings greater than or equal to 140/90 mm Hg, even though there were on medication that could have been prescribed for hypertension. Thirty-six percent of those who had evidence of hypertension were taking an ACE inhibitor. Thirty-two percent of those taking lipid-lowering medication had a total serum cholesterol value greater than or equal to 240 mg/dL. Statistically significant differences were noted for age and gender, with men and patients more than 85 years old generally having better measures of disease control.CONCLUSIONS: Many older Medicare patients with diabetes did not achieve recommended target levels of blood glucose, blood pressure, and lipids. GHb and serum cholesterol are not being monitored at recommended intervals. Significant opportunities exist to improve diabetes care for this population.