Improving and sustaining diabetes care in community health centers with the health disparities collaboratives
Improving and sustaining diabetes care in community health centers with the health disparities collaboratives
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DOI：
10.1097/mlr.0b013e31812da80e
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发表时间：
2007-12-01
期刊：
影响因子：
3
通讯作者：
Schaefer, Cynthia T.
中科院分区：
文献类型：
--
作者：
Chin, Marshall H.;Drum, Melinda L.;Schaefer, Cynthia T.
背景：1998年，卫生资源和服务管理局的初级卫生保健局开始了健康差异协作（HDC），以改善全国社区卫生中心（hc）的慢性病管理。HDC结合了快速质量改进、慢性护理模式和最佳实践学习课程。目的：确定HDC是否能改善hcc患者4年以上的糖尿病护理，以及更强化的干预是否能进一步提高护理水平。研究对象：分别于1998年、2000年和2002年在17个州的34个hc中随机选择2364、2417和2212名糖尿病患者。措施：美国糖尿病协会标准。研究设计：我们进行了一项嵌入前瞻性纵向研究的随机对照试验。我们随机选取了34例接受了1-2年HDC治疗的hcc患者。标准强度组继续基线HDC干预。高强度手臂中心接受了4次额外的学习课程、行为改变方面的提供者培训和患者授权材料。为了评估HDC的影响，我们分析了标准强度中心临床过程和结果的变化。为了确定更密集干预的效果，我们比较了标准和高强度中心。结果：1998年至2002年间，采用标准HDC的hcc改善了11个糖尿病病程，降低了血红蛋白Alc [-0.45%；95%可信区间（CI）， -0.72至-0.17]和低密度脂蛋白胆固醇（-19.7 mg/dL; 95% CI, -25.8至-13.6）。高强度干预中心血管紧张素转换酶抑制剂的使用较多[校正优势比（OR）， 1.47；（95% CI, 1.07-2.01）和阿司匹林（OR, 2.20; 95% CI, 1.28-3.76），但饮食（OR, 0.24; 95% CI, 0.08-0.68）和运动咨询（OR, 0.34; 95% CI, 0.15-0.75）的使用较少。结论：在HDC质量改善合作的前4年，hcc患者的糖尿病护理和预后得到改善。更密集的干预措施帮助不大。
Background: In 1998, the Health Resources and Services Administration's Bureau of Primary Health Care began the Health Disparities Collaboratives (HDC) to improve chronic disease management in community health centers (HCs) nationwide. The HDC incorporates rapid quality improvement, a chronic care model, and best practice learning sessions.Objectives: To determine whether the HDC improves diabetes care in HCs over 4 years and whether more intensive interventions enhance care further.Subjects: Chart review of 2364, 2417, and 2212 randomly selected patients with diabetes from 34 HCs in 17 states in 1998, 2000, and 2002, respectively.Measures: American Diabetes Association standards.Research Design: We performed a randomized controlled trial with an embedded prospective longitudinal study. We randomized 34 HCs that had undergone 1-2 years of the HDC. The standard-intensity arm continued the baseline HDC intervention. High-intensity arm centers received 4 additional learning sessions, provider training in behavioral change, and patient empowerment materials. To assess the impact of the HDC, we analyzed changes in clinical processes and outcomes in the standard-intensity centers. To determine the effect of more intensive interventions, we compared the standard- and high-intensity centers.Results: Between 1998 and, 2002, HCs undertaking the standard HDC improved 11 diabetes processes and lowered hemoglobin Alc [-0.45%; 95% confidence interval (CI), -0.72 to -0.17] and low-density lipoprotein cholesterol (-19.7 mg/dL; 95% CI, -25.8 to -13.6). High-intensity intervention centers had greater use of angiotensin converting enzyme inhibitors [adjusted odds ratio (OR), 1.47; 95% CI, 1.07-2.01] and aspirin (OR, 2.20; 95% CI, 1.28-3.76), but lower use of dietary (OR, 0.24; 95% CI, 0.08-0.68) and exercise counseling (OR, 0.34; 95% CI, 0.15-0.75).Conclusions: Diabetes care and outcomes improved in HCs during the first 4 years of the HDC quality improvement collaborative. More intensive interventions helped marginally.