A Quality Improvement Program to Reduce Potential Overtreatment of Diabetes Among Veterans at High Risk of Hypoglycemia.
A Quality Improvement Program to Reduce Potential Overtreatment of Diabetes Among Veterans at High Risk of Hypoglycemia.
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DOI：
10.2337/ds16-0006
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发表时间：
2017-08-01
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影响因子：
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通讯作者：
Shirley, Eric
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作者：
Vimalananda, Varsha G;DeSotto, Kristine;Shirley, Eric
背景. .强化血糖控制会增加低血糖的风险，对老年糖尿病患者几乎没有好处。该质量改进项目的目的是减少在VA新英格兰医疗保健系统中接受A1C治疗的患者数量，这些患者的A1C水平可能会带来更大的风险而不是收益（即潜在的过度治疗）。方法. .创建了提供者报告和临床提醒，以识别可能过度治疗的患者，并提示临床医生考虑去强化治疗。潜在的过度治疗患者被定义为那些使用胰岛素或磺脲类药物的患者，他们最近的糖化血红蛋白（A1C）为74岁，或被诊断为痴呆或认知障碍。统计2014年1 - 12月使用临床提示进行筛查和去强化治疗的患者人数。使用t检验比较基线时高风险退伍军人的数量与实施后6个月和18个月的数量。结果. .临床提示共筛查2830例患者；9.6%的患者血糖治疗去强化。在261例报告低血糖的患者中，37%的患者进行了降糖治疗。当报告的症状更严重时，治疗去强化的患者比例更高。在6个月时，高危人群的月平均水平比基线下降了18%，在18个月时下降了22% (P
Background.. Intensive glycemic control confers increased risk of hypoglycemia and little benefit among older individuals with diabetes. The aim of this quality improvement project was to reduce the number of patients treated to A1C levels that might confer greater risk than benefit (i.e., potential overtreatment) in the VA New England Healthcare System. Methods.. A provider report and clinical reminder were created to identify potentially overtreated patients and prompt clinicians to consider treatment de-intensification. Potentially overtreated patients were defined as those on insulin or a sulfonylurea whose most recent A1C was 74 years of age or diagnosed with dementia or cognitive impairment. The numbers of patients screened and whose treatment was de-intensified using the clinical reminder were counted from January to December 2014. The number of high-risk veterans at baseline was compared with that 6 and 18 months after implementation using t tests. Results.. A total of 2,830 patients were screened using the clinical reminder; 9.6% had their glycemic treatment de-intensified. Among the 261 patients reporting hypoglycemia, 37% had their treatment de-intensified. Higher percentages of patients had treatment de-intensified when reported symptoms were more severe. The monthly average in the high-risk cohort declined from baseline by 18% at 6 months and by 22% at 18 months (both P