Shared Medical Appointments: Impact on Clinical and Quality Outcomes in Veterans With Diabetes
Shared Medical Appointments: Impact on Clinical and Quality Outcomes in Veterans With Diabetes
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DOI：
10.1097/qmh.0000000000000098
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发表时间：
2016-07-01
影响因子：
1.2
通讯作者：
Higgins, Patricia A.
中科院分区：
文献类型：
--
作者：
Harris, Marianne D.;Kirsh, Susan;Higgins, Patricia A.
管理糖尿病对超过2910万受影响的美国人构成了巨大的挑战，并且在财政上对美国医疗保健系统来说是压倒性的。一种潜在的策略是利用小组方法来提供护理或共享医疗预约（SMA）。这项为期3年的回顾性VA研究的目的是调查使用SMA的2型糖尿病退伍军人和仅接受常规护理（UC）的退伍军人与医生一对一的临床和质量结局指标的差异。这项观察性的2组队列研究使用了来自中西部退伍军人管理局一家大型医院的摘要病历。临床结局指标包括血红蛋白A1 c（hbA 1 c）、收缩压、低密度脂蛋白胆固醇和急诊（艾德）访视。质量结果包括退伍军人管理局（VA）国防部糖尿病管理临床实践指南。在3年内回顾性检查了总计988例VA病例：371例使用SMA，617例在UC队列中，从未参加过糖尿病SMA。研究期间使用了2008年至2010年的VA医疗记录摘要。两组之间的HbA 1c、收缩压和艾德访视无统计学显著差异;然而，参加SMA的个体的HbA 1c为8.55（标准差[SD] = 1.72），UC为7.49（SD = 1.28）（P < .001）。SMA队列的所有临床结局在基线时均更差。UC患者的平均艾德访视次数/3年（平均值= 18.62，SD = 13.53，P < .001），而SMA患者的平均访视次数/3年（平均值= 27.97，SD = 14.00，P < .001）
Managing diabetes poses substantial challenges to the over 29.1 million Americans afflicted, and is financially overwhelming to the US health care system. One potential strategy is utilizing a group approach to care delivery or shared medical appointment (SMA). The purpose of this 3-year retrospective VA study was to investigate differences in clinical and quality outcome measures in veterans with type 2 diabetes who used SMAs and those who received only usual care (UC) one-on-one with their doctor. This observational, 2-group cohort study used abstracted medical records from a large Midwestern Veterans Administration hospital. Clinical outcome metrics included hemoglobin A1c (hbA1c), systolic blood pressure, low-density lipoprotein cholesterol, and emergency department (ED) visits. Quality outcomes included Veterans' Administration (VA) Department of Defense clinical practice guidelines for the management of diabetes. A total of 988 total VA cases were examined retrospectively over 3 years: 371 cases had used SMAs and 617 were in the UC cohort, and had never attended a diabetes SMA. The study period used abstracted VA medical records from 2008 to 2010. There were no statistically significant differences in HbA1c, systolic blood pressure, and ED visits between groups; however, hbA1c for individuals who attended SMAs was 8.55 (standard deviation [SD] = 1.72) and UC was 7.49 (SD = 1.28) (P < .001). All clinical outcomes were worse at baseline for the SMA cohort. UC had mean ED visits/3 years (mean = 18.62, SD = 13.53, P < .001) versus SMA participants (mean = 27.97, SD = 14.00, P