The Oregon Health Plan - Predictors of office-based diabetic quality of care
The Oregon Health Plan - Predictors of office-based diabetic quality of care
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DOI：
10.2337/diacare.24.2.262
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发表时间：
2001-02-01
期刊：
影响因子：
16.2
通讯作者：
Swigonski, N
中科院分区：
文献类型：
--
作者：
Srinivasan, M;Przybylski, M;Swigonski, N
目标-1994年，俄勒冈州健康计划（OHP）将基本医疗补助保险扩展到联邦贫困线以下的居民，采用了优先有限的福利方案，并转换为管理式医疗。以前没有描述过在主要医疗补助人群中罕见的糖尿病质量。在OHP登记者中，我们根据美国糖尿病协会指南检查糖尿病护理的预测因子，并将OHP糖尿病护理与国家基准进行比较。研究设计和方法-1995 - 1996年的图表摘要和医疗补助数据产生了996名18 - 64岁的非妊娠糖尿病患者，使用HbA（1c），血脂，和尿蛋白/微量白蛋白记录，我们构建了一个标准治疗（SC）指数：SC用于所有三种测试，混合护理（MC）用于一到两种测试，或者没有测试记录（NTD）。48 +/-11岁，63%为女性，有8 +/-5次医疗服务提供者就诊。提供者要求HbA（1c）（70%），尿微量白蛋白/蛋白（57%）和血脂（41%）测试。患者分为SC（22%）、MC（62%）或NTD（16%）。如果患者年龄在18 - 24岁之间，有更多的诊所就诊，每天服用胰岛素，在几个共病组中，参加受薪或资本化的健康计划，或住在医院床位较多的县，则有13个变量预测SC的可能性较高。四项研究被用来作为可比的国家benchmarried.CONCLUSIONS-护理提供给OHP糖尿病患者相比，有利的国家基准。然而，大多数OHP糖尿病患者仍然没有达到最佳罕见。研究SC的预测因子可能在进一步的政策制定中发挥重要作用。
OBJECTIVE- In 1994, the Oregon Health Plan (OHP) expanded basic Medicaid insurance to residents under the federal poverty limit, adopted a prioritized limited benefits package, and converted to managed care. The quality of rare in predominantly Medicaid populations with diabetes has not been previously described. In OHP enrollees, we examined predictors of diabetes care based on American Diabetes Association guidelines and described OHP diabetes care compared with national benchmarks.RESEARCH DESIGN AND METHODS- Chart abstraction and Medicaid data for 1995-1996 yielded 996 nonpregnant diabetic patients who were 18-64 years of age, Using HbA(1c), lipid panel, and urine protein/microalbumin documentation ordered during the study year, we constructed a standard care (SC) index: SC for all three tests, mixed care (MC) for one to two tests, or no tests documented (NTD).RESULTS- Our sample was predominantly white, 48 +/- 11 years of age, 63% women, with 8 +/- 5 provider visits. Providers ordered HbA(1c) (70%), urine microalbumin/protein (57%), and lipid panel (41%) tests. Patients distributed into SC (22%), MC (62%), or NTD (16%). Thirteen variables predicted St. Patients had a higher likelihood of SC if they were 18-24 years of age, had more clinic visits, were on insulin daily, were in several comorbid groups, were enrolled in salaried or capitated health plans, or lived in counties with more hospital beds. Four studies were used as comparable national benchmarks.CONCLUSIONS- Care provided to OHP patients with diabetes compares favorably with national benchmarks. Yet, most OHP patients with diabetes are still not achieving optimal rare. Examining predictors of SC may play an important role in further policy development.