Translating the chronic care model into the community - Results from a randomized controlled trial of a multifaceted diabetes care intervention
Translating the chronic care model into the community - Results from a randomized controlled trial of a multifaceted diabetes care intervention
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DOI：
10.2337/diacare.29.04.06.dc05-1785
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发表时间：
2006-04-01
期刊：
影响因子：
16.2
通讯作者：
Zgibor, JC
中科院分区：
文献类型：
--
作者：
Piatt, GA;Orchard, TJ;Zgibor, JC
目的-以确定是否使用慢性病护理模式（CCM）在一个欠发达的社区导致改善临床和行为的结果为people with diabetes.RESEARCH设计和METHODS -这个多层次的，集群设计，随机对照试验研究的有效性CCM为基础的干预在欠发达的城市社区。沿着11名初级保健实践者及其患者被随机分为三组：CCM干预组（n = 30例患者）、仅提供者教育组（PROV组）（n = 38）和常规护理组（UC组）（n = 51）。调整聚类后，相关性的大小仍然很强（P = 0.01）。在CCM组中，非HDL胆固醇的下降和自我监测血糖的参与者比例也观察到了相同的模式（非HDL胆固醇：-10.4 mg/dl，P = 0.24;自我监测血糖：+22.2%，P < 0.0001），组间改善差异具有统计学意义（非HDL胆固醇：P = 0.05;自我监测血糖：P = 0.03）。CCM组还显示出HDL胆固醇（+5.5 mg/dl，P = 0.0004）、糖尿病知识测试得分（+6.7%，P = 0.07）和授权得分（+2，P = 0.02hCCUSIONS-这些结果表明，在社区实施CCM可有效改善糖尿病患者的临床和行为结局。
OBJECTIVE - To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes.RESEARCH DESIGN AND METHODS - This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51).RESULTS - A marked decline in HbA(1c) was observed in the CCM group (-0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0,01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: -10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02).CONCLUSIONS - These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral Outcomes in patients with diabetes.