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项目和比较医生和健康计划。因此，了解哪些措施与临床结果最相关是很重要的。糖化血红蛋白（A1C）和低密度脂蛋白（LDL）筛查率是最广泛使用的糖尿病护理质量的过程测量方法，但存在多重局限性。该项目将开发和验证1)一种新的糖尿病护理质量过程测量方法，以及2)通过分析电子病历中的医生笔记文本来监测该测量方法的技术。需要制定的新措施：在高血糖和高脂血症的管理中加强治疗的频率。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，以确定抗高血压治疗的强化。从这项工作中得出的指标，即抗高血压强化治疗的频率，与血压控制密切相关。当前项目的目标是扩展这种创新方法，以开发和验证一种技术，该技术可用于高血糖和高脂血症治疗强化的持续测量。控制血糖和脂质可减少糖尿病并发症。然而，大多数患者没有达到推荐的血糖和低密度脂蛋白水平。为了改善糖尿病患者的护理，对糖尿病护理过程措施的依从性越来越受到监测。然而，目前使用的工艺措施与糖尿病预后改善相关的证据有限。因此，制定与结果密切相关的糖尿病护理过程措施是很重要的。对血压、血糖和低密度脂蛋白控制的一个越来越被认可的贡献是治疗

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.