Developing a quality measure for clinical inertia in diabetes care
Developing a quality measure for clinical inertia in diabetes care
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DOI：
10.1111/j.1475-6773.2005.00436.x
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发表时间：
2005-12-01
影响因子：
3.4
通讯作者：
Wong, AT
中科院分区：
文献类型：
--
作者：
Berlowitz, DR;Ash, AS;Wong, AT
目标。开发一种有效的质量测量方法，以捕获临床惯性，即未能根据医疗需要启动或加强治疗，在糖尿病护理中，并将此过程测量与血糖控制结果联系起来。数据源。1997年至1999年间13家退伍军人事务部医院的现有数据库。研究设计。收集了23,291名糖尿病患者的实验室结果、药物和诊断结果。我们模拟了在个人就诊时增加降糖药物的决定。然后，我们汇总了个体患者的所有就诊次数，并通过比较观察到的增加次数与基于我们模型的预期次数来计算治疗强度评分。然后检查治疗强度与两项血糖控制指标之间的关系，观察期间HbA1c的变化，以及结局糖化血红蛋白（HbA1c）是否大于8%。主要的发现。尽管39%的患者初始HbA1c水平大于8%，但只有9.8%的患者服用了增加的降糖药物。建立了一个临床可靠的预测治疗增加的模型，主要预测因子是近期HbA1c大于8%。患者接受的治疗强度有相当大的差异。接受强化治疗的患者在控制方面有更大的改善(p
Objective. To develop a valid quality measure that captures clinical inertia, the failure to initiate or intensify therapy in response to medical need, in diabetes care and to link this process measure with outcomes of glycemic control.Data Source. Existing databases from 13 Department of Veterans Affairs hospitals between 1997 and 1999.Study Design. Laboratory results, medications, and diagnoses were collected on 23,291 patients with diabetes. We modeled the decision to increase antiglycemic medications at individual visits. We then aggregated all visits for individual patients and calculated a treatment intensity score by comparing the observed number of increases to that expected based on our model. The association between treatment intensity and two measures of glycemic control, change in HbA1c during the observation period, and whether the outcome glycosylated hemoglobin (HbA1c) was greater than 8 percent, was then examined.Principal Findings. Increases in antiglycemic medications occured at only 9.8percent of visits despite 39percent of patients having an initial HbA1c level greater than 8 percent. A clinically credible model predicting increase in therapy was developed with the principal predictor being a recent HbA1c greater than 8 percent. There were considerable differences in the intensity of therapy received by patients. Those patients receiving more intensive therapy had greater improvements in control (p