Evaluation of a new care system provided to diabetic patients in the outpatient clinic
Evaluation of a new care system provided to diabetic patients in the outpatient clinic
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DOI：
10.2169/internalmedicine.39.783
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发表时间：
2000-10-01
影响因子：
1.2
通讯作者：
Kikkawa, R
中科院分区：
文献类型：
--
作者：
Hidaka, H;Terada, M;Kikkawa, R
目的评估糖尿病患者的代谢状态和慢性并发症对维持高质量的护理至关重要。我们对我校医院糖尿病患者常规门诊的护理质量进行了评估，并与新引进的标准化诊所的护理质量进行了比较，以评价新的护理体系。方法采用图表回顾法对1995年的护理质量进行评价，并与1996-1997年为标准化护理而系统设计的“糖尿病随访门诊”的护理质量进行比较。研究对象为1995年7 - 8月就诊的860例糖尿病或葡萄糖耐受不良患者。672例临床诊断为糖尿病的患者随访时间超过6个月。结果90%以上的患者在常规门诊进行了HbA（1c）、血脂和肌酐水平等实验室检查，但眼科转诊、24小时尿液收集测定肌酐清除率和白蛋白排泄、心电图检查不完善且记录不完整（40-60%的患者在前一年，70-80%的患者在最近2年）。在标准化的“糖尿病随访门诊”中，555例糖尿病患者中仅有4例24小时尿液采集失败，所有参与者均进行了踝部血压测量、神经传导研究、尼龙单丝测试等。95%以上的患者接受了眼科医生的眼底检查和心电图记录。结论引入规范化的“糖尿病随访门诊”可能是提高门诊服务质量和预防慢性糖尿病并发症的选择之一。
Objective Evaluation of metabolic states and chronic complications is essential for maintaining a high quality of care for diabetic patients. We have assessed the quality of care in routine outpatient clinics for diabetic subjects in our university hospital, and compared with those in a newly introduced standardized clinic to evaluate the new care system.Methods The quality of care was assessed by the chart review in 1995, and compared with those from 1996-1997 in the "Diabetes Follow-up Clinic" which is systematically designed for the standardized care,Patients The subjects were recruited among 860 patients who visited the outpatient clinic in July and August of 1995 with a diagnosis of diabetes or glucose intolerance. Six hundred seventy-two patients whose follow-up period had been more than 6 months with clinically diagnosed diabetes were used for the analysis.Results Laboratory tests such as determination of HbA(1c), and serum levels of lipids and creatinine were performed in more than 90% of the patients in the routine outpatient clinics, However, ophthalmology referral, 24-hour urine collection for the determination of creatinine clearance and albumin excretion, and electrocardiograms were not well performed and were incompletely documented (40-60% of the patients within a previous year and 70-80% in the last 2 years), In the standardized "Diabetes Follow-up Clinic", only four out of 555 diabetic patients failed to collect their 24-hour urine, and all participants had ankle blood pressure measurements, nerve conduction study, and nylon monofilament tests, etc. Furthermore, more than 95% of the patients had funduscopic examinations by ophthalmologists as well as records of electrocardiogram,Conclusion Introduction of the standardized 'Diabetes Follow-up Clinic" may be one of the choices for increasing the quality of outpatient care and for the prevention of chronic diabetic complications.