Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study
Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study
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DOI：
10.1136/bmj.38632.611123.ae
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发表时间：
2005-11-12
影响因子：
105.7
通讯作者：
Reeves, D
中科院分区：
文献类型：
--
作者：
Campbell, SM;Roland, MO;Reeves, D
目的探讨三种主要慢性病护理质量的变化（冠心病、哮喘和2型糖尿病）。设计纵向队列研究。在英格兰6个地理区域设置42个全科诊所（Avon，Bury/Rochdale，恩菲尔德，奥尔德姆，萨默塞特，南埃塞克斯）。结果1998年至2003年，1998年和2003年的1495例冠心病患者的护理质量明显提高，冠心病从60.5%上升到78.1%（变化= 17.6，95%置信区间13.9至21.4; P < 0.001），哮喘为60.1%至70.3%（10.2，4.6至15.8; P = 0.001），糖尿病为70.4%至77.7%（7.3，3.5至11.1; P = 0.001）。可能与改善健康成果有关的若干指标发生了重要变化。这些措施包括改善血清胆固醇的控制（
Objective To measure changes in quality of care for three major chronic diseases (coronary heart disease, asthma, and type 2 diabetes) between 1998 and 2003.Design Longitudinal cohort study.Setting 42 general practices in six geographical areas of England (Avon, Bury/Rochdale, Enfield, Oldham, Somerset, South Essex).Participants Medical record data for 2300 patients with diabetes, asthma, or coronary heart disease in 1998, and 1495 patients in 2003.Main outcome measure Quality of care assessed against predefined evidence based review criteria.Results Between 1998 and 2003, quality of care improved markedly in terms of maximum possible scores on the review criteria, from 60.5% to 78.1% for coronary heart disease (change = 17.6, 95% confidence interval 13.9 to 21.4; P < 0.001), 60.1% to 70.3% for asthma (10.2, 4.6 to 15.8; P = 0.001), and 70.4% to 77.7% for diabetes (7.3, 3.5 to 11.1; P = 0.001). Important changes occurred to several indicators potentially related to improved health outcomes. These included improved control of serum cholesterol (to