A controlled trial of population management - Diabetes mellitus: Putting evidence into practice (DM-PEP)
A controlled trial of population management - Diabetes mellitus: Putting evidence into practice (DM-PEP)
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DOI：
10.2337/diacare.27.10.2299
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发表时间：
2004-10-01
期刊：
影响因子：
16.2
通讯作者：
Meigs, JB
中科院分区：
文献类型：
--
作者：
Grant, RW;Cagliero, E;Meigs, JB
目的：人群水平的策略，组织和提供护理可能会改善糖尿病的管理。我们进行了一项多临床对照试验的人口管理与2型diabetes.RESEARCH设计和方法-我们创建了糖尿病患者登记（n = 3,079）的四个初级保健诊所在一个单一的学术健康中心。在干预诊所（n = 898）中，执业护士使用新型临床软件（PopMan）每周识别患者的访视和检测间隔以及最后测量的HbA（1c）、LDL胆固醇和血压水平的异常值。对于这些患者，执业护士通过电子邮件直接向初级保健提供者（PCP）发送简明的患者特定循证管理建议摘要。风险因素检测、药物处方和风险因素水平较基线的人群变化（2000年1月1日至2001年8月31日）将2001年12月1日至2003年7月31日期间，（n = 2，181）。结果-患者平均年龄为65岁，大多数是白色（81%），大多数人参加了医疗保险/医疗补助保险（62%）。从基线到随访，干预组检测HbA（1c）（P = 0.004）和LDL胆固醇（P < 0.001）的患者比例增加大于对照组。糖尿病相关药物处方和HbA（1c）、LDL胆固醇和血压水平的改善在干预诊所中被控制sites.CONCLUSIONS -人口水平的临床登记处结合PCP的总结建议对管理有适度的影响。干预是有限的良好的整体质量的基线和时间的改善，在所有控制诊所。目前尚不清楚这种干预是否会在整体质量较低的临床环境中产生更大的影响。需要进一步研究将人口登记资料转化为行动的更有效方法。
OBJECTIVE - Population-level strategies to organize and deliver care may improve diabetes management. We conducted a multiclinic controlled trial of population management in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS - We created diabetic patient registries (n = 3,079) for four primary care clinics within a single academic health center. In the intervention clinic (n = 898) a nurse practitioner used novel clinical software (PopMan) to identify patients on a weekly basis with outlying values for visit and testing intervals and last measured levels of HbA(1c), LDL cholesterol, an blood pressure. For these patients, the nurse practitioner e-mailed a concise patient-specific summary of evidence-based management suggestions directly to primary care providers (PCPs). Population changes in risk factor testing, medication prescription, and risk factor levels from baseline (1 January 2000 to 31 August 2001) to follow-up (1 December 2001 to 31 July 2003) were compared with the three usual-care control clinics (n = 2,181).RESULTS - Patients had a mean age of 65 years, were mostly white (81%), and the majority were insured by Medicare/Medicaid (62%). From baseline to follow-up, the increase in proportion of patients tested for HbA(1c) (P = 0.004) and LDL cholesterol (P < 0.001) was greater in the intervention than control sites. improvements in diabetes-related medication prescription and levels of HbA(1c), LDL cholesterol, and blood pressure in the intervention clinic were balanced by similar improvements in the control sites.CONCLUSIONS - Population-level clinical registries combined with summarized recommendations to PCPs had a modest effect on management. The intervention was limited by good overall quality of care at baseline and temporal improvements in all control clinics. It is unknown whether this intervention would have had greater impact in clinical settings with lower overall quality. Further research into more effective Methods of translating population registry information into action is required.