Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population
Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population
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DOI：
10.2337/diacare.26.7.2032
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发表时间：
2003-07-01
期刊：
影响因子：
16.2
通讯作者：
Wolfman, TE
中科院分区：
文献类型：
--
作者：
Clancy, DE;Cope, DW;Wolfman, TE
研究设计与方法：将120例未控制的2型糖尿病患者随机分为小组访视和常规护理两组，每组120例。6个月后，通过图表摘要评估与美国糖尿病协会(ADA)护理标准推荐的10项护理过程指标的一致性。评估的10个项目是最新的HbA(1c)、水平和血脂、尿微量白蛋白、适当使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、在有需要的情况下使用降血脂药、每天使用阿司匹林、每年足部检查、每年转诊视网膜检查、预防链球菌肺炎和流感免疫接种。结果-接受小组访问的患者在这10项护理过程指标的一致性方面有统计学上的显著改善(P<；0.001)。在患者中，。在迄今为止的10项指标中，76%的团体访视患者至少有9项指标，23%的对照组患者至少有9项指标；86%的团体访视患者至少有10项指标中的8项，而对照组患者的这一比例为47%。结论在治疗未参保或保险不足的2型糖尿病患者时，团体访视被证明比常规护理更有效地促进了与ADA护理标准的一致性。
OBJECTIVE - To evaluate the effectiveness of a. managed care approach to health care delivery, group visits, in the management of uninsured or inadequately insured patients with type 2 diabetes.RESEARCH DESIGN AND METHODS - A total of 120 patients with uncontrolled type 2 diabetes were randomly assigned to receive their care in group visits or usual care for, 6 months. After 6 months, concordance with 10 process-of-care indicators recommended by the American Diabetes Association (ADA) standards of care was evaluated through chart abstraction. The 10 items evaluated were up-to-date HbA(1c), levels and lipid profiles, urine for microalbumin, appropriate use of ACE inhibitor or angiotensin receptor blockers, use of lipid-lowering agents where indicated, daily aspirin use, annual foot examinations, annual referrals for retinal examinations, and immunizations against streptococcal pneumonia and influenza.RESULTS - Patients who received care in group visits showed Statistically significant improvement in concordance with these 10 process-of care indicators (P < 0.001). Of the patients,. of these 10 items up to date, as compared 76% who received care in group visits had at least 9 with 23% of control patients; 86% of patients in group visits had at least 8 of the 10 indicators compared with 47% of control patients.CONCLUSIONS - Group visits proved more effective in promoting concordance with ADA standards of care than usual care in the treatment of uninsured or inadequately insured patients with type 2 diabetes.