Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care
Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care
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DOI：
10.1111/1475-6773.12607
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发表时间：
2018-02-01
影响因子：
3.4
通讯作者：
Smith, Maureen A.
中科院分区：
文献类型：
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作者：
Magnan, Elizabeth M.;Bolt, Daniel M.;Smith, Maureen A.
目的 寻找糖尿病患者中临床相关的慢性病组合，并检查其与六种糖尿病质量指标的关系。数据来源/研究背景 2010-2011 年期间，在美国中西部八个卫生系统就诊的 29562 名成年糖尿病患者。研究设计我们回顾性评估了六种糖尿病质量指标与患者慢性病组合之间的关系。我们分析了 12 种与糖尿病护理一致的病症，根据病症共现定义了五种相互排斥的病症（类别）组合。我们使用逻辑回归来量化病情类别和质量指标之间的关系，并根据患者人口统计和利用率进行调整。数据收集我们使用标准化算法提取电子健康记录数据。主要发现我们发现以下病情类别：严重心脏病、心脏病、非心血管疾病、危险因素和无一致合并症。与无合并症的类别相比，血糖控制的调整后比值比和 95% 置信区间分别为 1.95 (1.7-2.2)、1.6 (1.4-1.9)、1.3 (1.2-1.5) 和 1.3 (1.2-1.4)。结果显示其他指标的类似模式。结论患者根据病情类别具有不同的质量指标成就，而病情不太严重的类别的患者实现糖尿病指标的可能性较小。
ObjectiveTo find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics.Data Sources/Study SettingTwenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010-2011.Study DesignWe retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions (classes) based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization.Data CollectionWe extracted electronic health record data using a standardized algorithm.Principal FindingsWe found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7-2.2), 1.6 (1.4-1.9), 1.3 (1.2-1.5), and 1.3 (1.2-1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics.ConclusionsPatients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.