Quality of Care Among Obese Patients
Quality of Care Among Obese Patients
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DOI：
10.1001/jama.2010.339
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发表时间：
2010-04-07
影响因子：
120.7
通讯作者：
Werner, Rachel M.
中科院分区：
文献类型：
--
作者：
Chang, Virginia W.;Asch, David A.;Werner, Rachel M.
临床医生通常对肥胖持消极态度，并对肥胖患者的护理表示不满。此外，肥胖患者经常觉得临床医生因为他们的体重而有偏见或不尊重。这些观察结果引起了人们的关注，肥胖患者可能会收到较低的quality of care. ObjectiveTo确定普通门诊质量指标的表现是否因患者体重状况而异。设计、设置和参与者在2个国家级患者人群中检查了8种不同的表现指标：（1）医疗保险受益人（n=36 122）使用来自Medicare受益人调查的数据（1994-2006年）;以及（2）退伍军人健康管理局（VHA）的护理接受者（n=33 550）使用来自正在进行的性能评估项目的数据（2003-2004年）。主要结果测量符合糖尿病护理条件的患者的绩效测量（眼部检查、糖化血红蛋白[HbA（1c）]检测和脂质筛查）、肺炎球菌疫苗接种、流感疫苗接种、筛查性乳房X线检查、结直肠癌筛查，和子宫颈癌检查。措施的基础上相结合的行政索赔，调查和图表审查data.Results我们没有发现任何证据表明，肥胖或超重的患者不太可能接受推荐的治疗相对于正常体重的患者。此外，肥胖和/或超重患者的成功率在几项指标上略高。在医疗保险受益人中，观察到推荐的糖尿病护理最显著的差异：比较肥胖与正常体重的糖尿病患者，肥胖患者更有可能接受脂质筛查的推荐护理（72% vs 65%;比值比，1.37 [95%置信区间，1.09-1.73]）和HbA（1c）检验（74% vs 62%;比值比，1.73 [95%置信区间，1.41-2.11]）。所有的分析进行了调整，社会人口因素，健康状况，临床复杂性，和访问frequency.Conclusions样本的患者从医疗保险和VHA人群中，没有证据表明，在8个性能指标，肥胖或超重的患者接受较差的照顾时，与正常体重的患者相比。肥胖或超重与几项措施的推荐护理率略高有关。美国医学会杂志2010;303（13）：1274-1281
Context Clinicians often have negative attitudes toward obesity and express dissatisfaction in caring for obese patients. Moreover, obese patients often feel that clinicians are biased or disrespectful because of their weight. These observations raise the concern that obese patients may receive lower quality of care.Objective To determine whether performance on common outpatient quality measures differs by patient weight status.Design, Setting, and Participants Eight different performance measures were examined in 2 national-level patient populations: (1) Medicare beneficiaries (n=36 122) using data from the Medicare Beneficiary Survey (1994-2006); and (2) recipients of care from the Veterans Health Administration (VHA) (n=33 550) using data from an ongoing performance-evaluation program (2003-2004).Main Outcome Measures Performance measures among eligible patients for diabetes care (eye examination, glycated hemoglobin [HbA(1c)] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening. Measures were based on a combination of administrative claims, survey, and chart review data.Results We found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients. Moreover, success rates were marginally higher for obese and/or overweight patients on several measures. The most notable differentials were observed for recommended diabetes care among Medicare beneficiaries: comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%; odds ratio, 1.37 [95% confidence interval, 1.09-1.73]) and HbA(1c) testing (74% vs 62%; odds ratio, 1.73 [95% confidence interval, 1.41-2.11]). All analyses were adjusted for sociodemographic factors, health status, clinical complexity, and visit frequency.Conclusions Among samples of patients from the Medicare and VHA populations, there was no evidence across 8 performance measures that obese or overweight patients received inferior care when compared with normal-weight patients. Being obese or overweight was associated with a marginally higher rate of recommended care on several measures. JAMA. 2010;303(13):1274-1281