Diabetes care quality in the Veterans Affairs health care system and commercial managed care: The TRIAD study
Diabetes care quality in the Veterans Affairs health care system and commercial managed care: The TRIAD study
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DOI：
10.7326/0003-4819-141-4-200408170-00007
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发表时间：
2004-08-17
影响因子：
39.2
通讯作者：
Mangione, CM
中科院分区：
文献类型：
--
作者：
Kerr, EA;Gerzoff, RB;Mangione, CM
背景资料：没有研究比较护理在退伍军人事务部（VA）与商业管理的医疗机构，也没有研究集中在深入的护理比较慢性，门诊conditions.Objective：比较糖尿病护理质量之间的患者在VA系统和那些登记在商业管理的医疗机构通过使用等效的抽样和测量方法。设计：横断面患者调查，回顾性审查医疗记录。设置：5个VA医疗中心和8个商业管理护理组织，在5个匹配的地理区域。参与者：8205名糖尿病患者：1285名在VA系统，6920名在商业管理护理。测量：我们比较了7个糖尿病护理过程和3个糖尿病中间结果的相同指定质量测量以及4个满意度维度的得分。得分以接受指定护理的患者百分比表示，并根据患者的人口统计学和健康特征进行调整。结果：VA系统中的患者在所有过程测量中的得分均优于商业管理护理中的患者（例如，每年血红蛋白A（1c）为93% vs. 83%; P= 0.006;每年眼科检查为91% vs. 75%; P < 0.001）。两组的血压控制都很差（52%至53%的人血压< 140/90 mm Hg），但VA系统的患者对低密度脂蛋白胆固醇和血红蛋白Alc的控制更好（例如，86%对72%的低密度脂蛋白胆固醇水平< 3.37 mmol/L [
Background: No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions.Objective: To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods.Design: cross-sectional patient survey with retrospective review of medical records.Setting: 5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions.Participants: 8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care.Measurements: we compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics.Results: Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin A(1c); P= 0.006; 91% vs. 75% for annual eye examination; P < 0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure < 140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin Alc (for example, 86% vs. 72% for low-density lipoprotein cholesterol level < 3.37 mmol/L [