Improving the management of chronic disease at community health centers
Improving the management of chronic disease at community health centers
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DOI：
10.1056/nejmsa062860
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发表时间：
2007-03-01
影响因子：
158.5
通讯作者：
Guadagnoli, Edward
中科院分区：
文献类型：
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作者：
Landon, Bruce E.;Hicks, LeRoi S.;Guadagnoli, Edward
背景：卫生资源和服务管理局（HRSA）的健康差异协作项目旨在改善社区卫生中心的护理，许多少数民族和种族群体的患者以及未投保的患者在社区卫生中心接受治疗。方法：我们对社区卫生中心进行了一项干预前和干预后的对照研究，这些社区卫生中心参与了质量改善协作（由HRSA赞助的健康差异协作），用于治疗糖尿病、哮喘或高血压患者。我们在44个参与协作的干预中心和20个未参与的干预中心（外部控制中心）招募了9658名患者。每个干预中心还作为另一种情况的内部控制。从每个卫生中心的医疗记录中提取质量指标。我们通过标准化和平均所有适用措施的分数来创建总体质量分数。使用控制患者特征的层次回归模型评估质量的变化。结果：总体而言，干预中心对哮喘和糖尿病患者的护理质量综合指标的改善明显大于外部控制中心和内部控制中心，但对高血压患者的护理质量没有改善。与外部控制中心相比，干预中心在预防和筛查措施方面有显著改善，包括对糖尿病患者的足部检查增加了21%，在疾病治疗和监测方面，包括对哮喘使用抗炎药物增加了14%，糖化血红蛋白评估增加了16%。然而，在评估的任何中间结局（哮喘的紧急护理或住院治疗，糖尿病的糖化血红蛋白水平的控制，高血压的血压控制）中没有任何改善。结论：健康差异协作显著改善了所研究的三种疾病中的两种的护理过程。所研究的临床结果没有改善。
BACKGROUND:The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority groups and uninsured patients receive treatment.METHODS:We performed a controlled preintervention and postintervention study of community health centers participating in quality-improvement collaboratives (the Health Disparities Collaboratives sponsored by the HRSA) for the care of patients with diabetes, asthma, or hypertension. We enrolled 9658 patients at 44 intervention centers that had participated in the collaboratives and 20 centers that had not participated (external control centers). Each intervention center also served as an internal control for another condition. Quality measures were abstracted from medical records at each health center. We created overall quality scores by standardizing and averaging the scores from all of the applicable measures. Changes in quality were evaluated with the use of hierarchical regression models that controlled for patient characteristics.RESULTS:Overall, the intervention centers had considerably greater improvement than the external and internal control centers in the composite measures of quality for the care of patients with asthma and diabetes, but not for those with hypertension. As compared with the external control centers, the intervention centers had significant improvements in the measures of prevention and screening, including a 21% increase in foot examinations for patients with diabetes, and in disease treatment and monitoring, including a 14% increase in the use of antiinflammatory medication for asthma and a 16% increase in the assessment of glycated hemoglobin. There was no improvement, however, in any of the intermediate outcomes assessed (urgent care or hospitalization for asthma, control of glycated hemoglobin levels for diabetes, and control of blood pressure for hypertension).CONCLUSIONS:The Health Disparities Collaboratives significantly improved the processes of care for two of the three conditions studied. There was no improvement in the clinical outcomes studied.