A set of four simple performance measures reflecting adherence to guidelines predicts hospitalization: a claims-based cohort study of patients with diabetes.
A set of four simple performance measures reflecting adherence to guidelines predicts hospitalization: a claims-based cohort study of patients with diabetes.
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DOI：
10.2147/ppa.s99895
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发表时间：
2016
影响因子：
2.2
通讯作者：
Rosemann T
中科院分区：
文献类型：
--
作者：
Huber CA;Brändle M;Rapold R;Reich O;Rosemann T
指南依从性和结果之间的联系是糖尿病护理中一个非常需要解决的问题。我们的目标是使用一组简单的绩效指标来评估糖尿病患者对指南的遵守情况及其对住院的影响。我们进行了一项回顾性队列研究，使用接受治疗的糖尿病成人患者的医疗保健索赔数据（2011-2013年）。将患者分为3个药物治疗组（仅口服降糖药[OAs]、与胰岛素联合给药和仅胰岛素给药）。绩效指标基于国际糖尿病护理指南。多变量logistic回归模型预测了所有治疗组中按依从性水平（2011）的住院概率（2013）。2011年共招募了40，285名糖尿病患者。指南遵守率相当低：约70%的患者每两年接受一次血红蛋白A1 c测量，19.8%的患者每年接受一次低密度脂蛋白胆固醇测试。只有4.8%的患者完全依从，包括所有性能指标（口服降糖药：3.7%;胰岛素：7.7%;联合用药：7.2%）。指南依从性的增加与住院概率的降低相关。这种效应在联合使用OA和胰岛素的患者中最强。我们的研究表明，根据现有的数据集，可以很容易地计算出反映医生在糖尿病护理中遵守指南的措施。此外，这些措施显然与住院的可能性有关，这表明医生更好地遵守指南可能有助于防止大量住院。
The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We aimed to assess the adherence to guidelines and its impact on hospitalization using a simple set of performance measures among patients with diabetes. We performed a retrospective cohort study, using health care claims data for adult patients with treated diabetes (2011–2013). Patients were categorized into three drug treatment groups (with oral antidiabetic agents [OAs] only, in combination with insulin, and insulin only). Performance measures were based on international established guidelines for diabetes care. Multivariate logistic regression models predicted the probability of hospitalization (2013) by adherence level (2011) among all treatment groups. A total of 40,285 patients with diabetes were enrolled in 2011. Guideline adherence was quite low: about 70% of all patients received a biannual hemoglobin A1c measurement and 19.8% had undergone an annual low-density lipoprotein cholesterol test. Only 4.8% were exposed to full adherence including all performance measures (OAs: 3.7%; insulin: 7.7%; and in combination: 7.2%). Increased guideline adherence was associated with decreased probability of hospitalization. This effect was strongest in patients using OAs and insulin in combination. Our study showed that measures to reflect physicians’ guideline adherence in diabetes care can easily be calculated based on already available datasets. Furthermore, these measures are clearly linked with the probability of hospitalization suggesting that a better guideline adherence by physicians could help to prevent a large number of hospitalizations.