Quality of outpatient care provided to diabetic patients. A health maintenance organization experience
Quality of outpatient care provided to diabetic patients. A health maintenance organization experience
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DOI：
10.2337/diacare.19.6.601
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发表时间：
1996-06-01
期刊：
影响因子：
16.2
通讯作者：
Davidson, MB
中科院分区：
文献类型：
--
作者：
Peters, AL;Ossorio, RC;Davidson, MB
目的-记录一个大型健康维护组织(HMO)从1993年1月1日到1994年1月1日为患者提供的糖尿病护理质量，并将其与美国糖尿病协会(ADA)的标准进行比较。研究设计和方法-为了满足健康计划和雇主数据信息集(HEDIS)的要求，加利福尼亚州的一个主要HMO确定了14,539名糖尿病患者，并随机选择了384人进行审查。这些患者中有353人有图表，在获得HEDIS审查的信息后，外部图表审查员从图表中提取了额外的信息。这一数据集被用于分析参与医疗小组在一年内为这些HMO成员提供的糖尿病护理的质量，并检查了一年中血糖和血脂控制措施的绝对值和测量频率。这些结果与ADA的护理标准进行了比较。结果：尽管患者在一年中平均去看他们的初级保健医生(PCP)4.5次，但21%的人每年去看一次或更少。56%的患者没有糖化血红蛋白水平的记录(ADA建议每年进行两到四次测量)，在那些测量了糖化血红蛋白水平的患者中，39%的患者至少有一个数值大于或等于10%。65%的患者没有记录空腹血糖浓度(建议每年四到六次)。94%的患者没有足部检查(应该在每次定期就诊时进行)。52%的患者没有进行尿蛋白测定。此外，许多患者的血脂异常升高且未经治疗。结论-尽管这些患者中的许多患者在一年中经常去PCP就诊，但糖尿病的管理是不够的。缺乏足够的预防性护理将导致患糖尿病急性和慢性并发症的风险增加，给卫生保健系统造成更大的未来负担，并给患者带来负面后果。
OBJECTIVE - To document the quality of diabetes care provided to patients in a large health maintenance organization (HMO) from 1 January 1993 to 1 January 1994 and compare it to the standards of the American Diabetes Association (ADA).RESEARCH DESIGN AND METHODS - To meet a Health Plan and Employer Data Information Set (HEDIS) requirement, a major HMO in California identified 14,539 members with diabetes and randomly selected 384 individuals for review. Charts were available on 353 of these patients, and after obtaining the information for the HEDIS review, additional information was extracted from the charts by an outside chart reviewer. This data set was used for an analysts of the quality oi diabetic care provided by the participating medical groups to these HMO members during 1 year Documentation of follow-up and measures of glycemic and lipid control was examined both for absolute values and for the frequency of measurement over the year. These results were compared to the ADA standards oi care.RESULTS - Although patients averaged 4.5 visits to their primary care physicians (PCPs) over the year, 21% had one or fewer visits per year. Glycated hemoglobin levels were not documented in 56% of patients (ADA recommends two to four measurements per year), and of those with a glycated hemoglobin level measured, 39% had at least one value greater than or equal to 10%. Fasting plasma glucose concentrations were not documented in 65% of patients (four to six per year recommended). Foot exams (which should be performed at each regular visit) were not documented for 94% of patients. Urine protein measurements were not performed in 52% of patients. Additionally, many patients had elevated and untreated lipid abnormalities.CONCLUSIONS - In spite of the frequency of PCP visits during the year for many of these patients, diabetes management was inadequate. This lack of adequate preventive care will lead to an increased risk of the development of the acute and chronic complications of diabetes, creating an even greater future burden on the health care system and negative consequences for patients.