Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis.
Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis.
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DOI：
10.9778/cmajo.20170022
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发表时间：
2017-07-24
期刊：
影响因子：
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通讯作者：
Guttmann, Astrid
中科院分区：
文献类型：
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作者：
Nakhla, Meranda;Rahme, Elham;Guttmann, Astrid
背景：安大略儿科糖尿病项目网络于2001年实施。本研究的目的是确定网络的实施是否与急性糖尿病相关并发症的风险降低和减少社会经济和地理差异，这些outcome.METHODS：我们进行了基于人口的时间趋势分析儿童（< 18岁）糖尿病使用卫生行政数据库在安大略从1996年至2011年。我们确定了网络的实施和糖尿病相关的急诊室访问和住院之间的关系，使用线性混合效应模型与Poisson链接function.RESULTS：数据为13 806名儿童糖尿病进行了分析。该网络实施后，每100名儿童的急诊就诊率（2001年为17.0比2011年为10.00，p < 0.001）和住院率（8.8比5.0，p < 0.001）显著下降。在社会经济地位最低的五分之一人口和城市地区，这一下降最为显著。实施网络后，社会经济最低五分位数的儿童急诊就诊（校正率比[RRafter] 1.77 [95%置信区间（CI）1.55 - 2.03]）和住院（RRafter 2.11 [95% CI 1.77 - 2.52]）的风险仍然高于社会经济最高五分位数的儿童。然而，在网络实施后，最低社会经济五分位数与最高社会经济五分位数相比，急诊就诊率和住院率的年度下降趋势趋于下降（p < 0.05）。在该网络实施之前，地理位置与结果无关。实施后，来自城市地区的患者之间的急诊就诊的风险显着低于农村地区的患者。解释：建立一个儿科糖尿病网络与更好的健康结果，特别是对患者的社会经济地位较低。需要进一步努力解决农村地区的保健需求。
BACKGROUND: The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes.METHODS: We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function.RESULTS: Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RRafter] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RRafter 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas.INTERPRETATION: The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas.