Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets
Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets
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DOI：
10.1093/intqhc/mzi010
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发表时间：
2005-04-01
影响因子：
2.6
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Plantinga, LC;Jaar, BG;Powe, NR
Objective.为了检查医生联系的频率是否与反映慢性肾脏病患者临床表现的公认护理质量指标相关。终末期肾病患者的前瞻性队列研究开始于1995年，随访2.5年。76个非营利的美国透析诊所。研究参与者。678例事件血液透析患者，我们有每个诊所的患者-医生接触的平均频率信息（低，每月或更少频率;中等，每月和每周之间;高，超过每周），通过临床调查确定。主要结局指标。达到公认的6个月临床性能目标：白蛋白（>= 3.5 g/dl）、磷酸钙（Ca-P）乘积（= 1.2）、血管通路类型（瘘）和血红蛋白（>= 11 g/dl）。通过logistic回归分析，在报告医生联系频率较低的诊所接受治疗的患者实现大多数目标的几率较低，白蛋白的差异具有统计学意义[低，调整后的比值比（OR）= 0.83，95%置信区间（CI），0.55-1.25;中等，调整后的OR = 0.62，95% CI，0.42-0.93;参考，高]和透析剂量（低水平，校正OR = 0.26，95% CI，0.08-0.89;中等水平，校正OR = 0.67，95% CI，0.20-2.27）;然而，他们实现血红蛋白目标的几率更大（低，调整后OR = 1.94，95% CI，1.24-3.04;中等，调整后OR = 1.89，95% CI，1.27-2.83）。此外，每月一次或少于每月一次组达到目标的数量在统计学上显著较低（调整后OR = 0.43，95%CI，0.20-0.94）。更频繁的患者-医生接触与慢性肾脏病护理临床绩效目标的实现呈正相关。
Objective. To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients.Design. Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years.Setting. 76 not-for-profit US dialysis clinics.Study participants. 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey.Main outcome measures. Achievement of accepted 6 month clinical performance targets of albumin (>= 3.5 g/dl), calcium-phosphate (Ca-P) product (= 1.2), vascular access type (fistula), and hemoglobin (>= 11 g/dl).Results. By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94).Conclusions. More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.