Monitoring Intensification of Treatment for Hyperglycemia and Hyperlipidemia

描述(由申请人提供)：糖尿病护理质量测量越来越多地被用于评估质量改进计划以及比较医生和健康计划。因此，了解哪些指标与临床结果最相关是很重要的。最广泛使用的糖尿病护理质量过程指标--糖化血红蛋白和低密度脂蛋白筛查率--有多种局限性。该项目将开发和验证1)新的糖尿病护理质量过程衡量标准和2)通过分析电子病历中的医生笔记文本来监测该衡量标准的技术。有待开发的新措施：加强高血糖和高脂血症管理的治疗频率。在之前的工作中，我们成功地开发了一种技术，使我们能够分析医生笔记的文本，以识别抗高血压治疗的强化。从这项工作中得出的测量方法，即抗高血压治疗强化的频率，与血压控制密切相关。当前项目的目标是扩展这一创新方法，以开发和验证一种可用于持续测量高血糖和高脂血症治疗强化程度的技术。控制血糖和血脂可减少糖尿病并发症。然而，大多数患者并没有达到推荐的血糖和低密度脂蛋白水平。为了改善对糖尿病患者的护理，越来越多地监测对糖尿病护理过程措施的遵守情况。然而，目前使用的过程措施与糖尿病预后改善相关的证据有限。因此，开发与预后密切相关的糖尿病护理流程措施是很重要的。越来越多的人认识到，控制血压、血糖和低密度脂蛋白的一个因素是治疗 在就诊期间，这些情况很少会加剧。低频率的强化治疗与高血压和糖化血红蛋白升高的发病率有关。此外，旨在增加强化治疗频率的干预措施已被证明可降低A1C水平。因此，评估强化治疗高血糖和高脂血症的有效指标可以作为一种过程性指标，为临床医生提供有意义的改善结果的基础。目前确定强化治疗的黄金标准是资源密集型人工记录审查。这阻碍了对强化治疗的广泛测量。电子病历系统日益流行，其中包括医生笔记的计算机化文本，这为监测治疗强度的新方法提供了机会。在这个项目中，我们将扩展我们以前在高血压方面所做的工作，以开发和验证一种技术，该技术可以用于持续测量糖尿病患者的高血糖和高脂血症的治疗强度。

DESCRIPTION (Provided by the Applicant): Diabetes quality-of-care measurement is increasingly being used to evaluate quality improvement programs and to compare physicians and health plans. It is therefore important to know which measures are best associated with clinical outcomes. The most widely used process measures of diabetes quality-of-care, A1C and LDL screening rates, have multiple limitations. This project will develop and validate 1) a new diabetes quality-of-care process measure and 2) the technology for monitoring that measure using analysis of the text of physician notes in the EMR. New Measure to be Developed: frequency of treatment intensification in the management of hyperglycemia and hyperlipidemia. In prior work we successfully developed a technique that allowed us to analyze the text of physician notes to identify anti-hypertensive treatment intensification. The measure derived from that work, frequency of antihypertensive treatment intensification, was strongly associated with blood pressure control. The objective of the current project is to extend this innovative approach to develop and validate a technique that could be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia. Blood glucose and lipid control reduce diabetes complications. Nevertheless, recommended glucose and LDL levels are not achieved in the majority of patients. To improve care of diabetic patients, adherence to the process measures of diabetes care is increasingly monitored. However, the evidence that the currently used process measures are associated with improvement in diabetes outcomes is limited. It is therefore important to develop process measures of diabetes care that are strongly associated with outcomes. An increasingly recognized contributor to blood pressure, glucose and LDL control is that treatment for these conditions is rarely intensified during physician visits. Low frequency of treatment intensification has been linked to increased prevalence of elevated blood pressure and A1C. Furthermore, interventions aimed at increasing the frequency of treatment intensification have been demonstrated to lower A1C levels. Therefore a validated metric that evaluates intensification of treatment of hyperglycemia and hyperlipidemia could function as a process measure that provides a meaningful basis for clinicians to improve their outcomes. The gold standard for identifying treatment intensification currently is resource-intensive manual record review. This hinders widespread measurement of treatment intensification. Growing prevalence of electronic medical record systems that include computerized text of physician notes provides an opportunity for a novel approach to monitoring treatment intensification. In this project, we will expand the work we previously carried out in hypertension to develop and validate a technique that can be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia in diabetic patients.