Possibilities and challenges of a large international benchmarking in pediatric diabetology-The SWEET experience
Possibilities and challenges of a large international benchmarking in pediatric diabetology-The SWEET experience
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DOI：
10.1111/pedi.12432
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发表时间：
2016-10-01
影响因子：
3.4
通讯作者：
Veeze, Henk
中科院分区：
文献类型：
--
作者：
Witsch, Michael;Kosteria, Ioanna;Veeze, Henk
目的：尽管存在治疗糖尿病儿童的循证指南，但在知识、态度和实践方面仍然存在广泛的差距。本文的目的是回顾这一过程在SNET中的实践和结果，并重点讨论当前的挑战和未来的方向。方法：每两年一次，成员以电子方式将37个参数的非识别临床数据传输到SNET数据库。每个中心收到基准和数据验证报告。结果：2015年，48个中心提供了20165名独立患者的数据(51.6%为男性)。排除缺失数据后，仍有19131名患者需要进一步分析。年龄中位数为14.2岁，糖尿病病程中位数为4.8年；96.0%的患者为1型糖尿病，1.1%为2型糖尿病，2.9%为其他糖尿病类型。数据的完整性随着时间的推移而增加。2015年，1型糖尿病患者HbA1c中位数为7.8%(61.7 mmol/mol)，其中HbA1c中位数为39.1%，HbA1c中位数为41.4%，HbA1c中位数为7.5%，糖化血红蛋白中位数为7.5%，糖化血红蛋白中位数为9%。虽然HbA1c随着时间的推移一直保持稳定[7.7%-7.8%(60.7-61.7 mmol/mol)]，但中心之间仍然存在很大的差异。14个中心的HbA1c和HbA1c；中位数为7.5%(58 mmol/mol)。结论：我们的愿景是，参与SNET正在鼓励成员提供越来越准确和完整的数据。传播成果和预期项目是改进数据报告的进一步动力。比较过程和结果将帮助成员找出弱点并引入创新的解决方案，从而改善对糖尿病患者的护理，使其更加统一。
Aim: Despite the existence of evidence-based guidelines for the care of children with diabetes, widespread gaps in knowledge, attitude, and practice remain. The purpose of this paper is to present a review of benchmarking practices and results of this process within SWEET, moreover focusing on current challenges and future directions.Methods: Biannually, members electronically transfer de-identified clinic data for 37 parameters to the SWEET database. Each center receives benchmarking and data validation reports.Results: In 2015, 48 centers have contributed data for 20 165 unique patients (51.6% male). After exclusion for missing data 19 131 patients remain for further analysis. The median age is 14.2 years, with a median diabetes duration 4.8 years; 96.0% of patients have type 1, 1.1% type 2, and 2.9% other diabetes types. Data completeness has increased over time. In 2015, median HbA1c of all patients' (diabetes type 1) medians was 7.8% (61.7 mmol/mol) with 39.1%, 41.4%, and 19.4% of patients having HbA1c < 7.5% (58 mmol/mol), 7.5%-9% (58-75 mmol/mol) and >9% (75 mmol/mol), respectively. Although HbA1c has been stable over time [7.7%-7.8% (60.7-61.7 mmol/mol)], there remains wide variation between centers. Fourteen centers achieve a median HbA1c < 7.5% (58 mmol/mol).Conclusions: Our vision is that the participation in SWEET is encouraging members to deliver increasingly accurate and complete data. Dissemination of results and prospective projects serve as further motivation to improve data reporting. Comparing processes and outcomes will help members identify weaknesses and introduce innovative solutions, resulting in improved and more uniform care for patients with diabetes.