Relation of Primary Care Practice Variation to the Prevention of CVD and Diabetes

初级保健实践变化与预防 CVD 和糖尿病的关系

• 批准号: 7462403
• 负责人: THOMAS MICHAEL VOGT
• 金额: $ 35.55万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7462403
• 关键词: Adherence; Adult; Affect; Atherosclerosis; Blood Pressure; Body Weight Changes; Cardiovascular Diseases; Caring; Characteristics; Clinical; Clinical Practice Variations; Complications of Diabetes Mellitus; Computerized Medical Record; Consensus; Costs and Benefits; Data; Diabetes Mellitus; Disease Management; Electronics; Enrollment; Event; Feedback; Future; Guidelines; Hawaii; Health Care Costs; Health system; Individual; Integrated Health Care Systems; Internet; Intervention; Knowledge; Left; Lipids; Measures; Medical; Medical Care Team; Methodology; Methods; Morbidity - disease rate; Outcome; Patients; Patterns of Care; Persons; Population; Practice Guidelines; Practice Management; Prevention; Preventive; Primary Health Care; Proliferating; Prophylactic treatment; Public Health; Quality of Care; Range; Rate; Recommendation; Records; Relative (related person); Research; Research Personnel; Resources; Risk; Risk Factors; Risk Management; Score; Screening procedure; Services; Shapes; System; Text; Time; Variant; Weight; Work; base; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; cost; cost effectiveness; diabetes risk; diabetic cardiomyopathy; evidence based guidelines; experience; health care service utilization; improved; indexing; mortality; phosphatidylinositol phosphate; prevent; prevention evaluation; response; social; tool

DESCRIPTION (provided by applicant): Diabetes is a major risk factor for cardiovascular disease (CVD) and for disabling complications. Although a great deal of rhetoric and resources are expended on trying to prevent these morbidities, there is little direct evidence on how individual clinical practice variations can influence morbid and mortal events and health-care costs among persons with diabetes and CVD risk factors. This project will use an electronic medical record system in a population of 16,000 adult persons with diabetes who are enrolled in a large integrated health-care system to determine the relation of variations in clinical prevention and management to the trajectories of diabetic and CVD morbid events over a 5-10 year period. The study focuses on the variations over time in care management at the practitioner level. The study will examine risk factor change (weight, blood pressure, lipids, etc.) over time, and summarize those changes into quality of care indices using a person-time methodology developed by the investigators. Quality of disease management will be summarized into two subscales: 1) the Atherosclerotic Cardiovascular Disease (ASCVD) Prevention Index (PI), which includes screening for CVD risk and risk of diabetes complications; and 2) the Time and Level of Control (TLC) of CVD and diabetes risk management. These sub-scales are then summarized into an overall Diabetes-CVD Prevention Index (DCPI). The study will use practice and patient characteristics to predict the quality measures in order to identify the practice, patient, and practitioner features that predict good management and to determine the variation in quality of risk management across practices. Finally, the study will use the quality measures to predict morbid and mortal outcomes over the 5-10 year period. This study will demonstrate the range in adherence to practice guidelines (which preliminary data suggest is very wide) in managing diabetes and CVD risk and the relation of that practice variation to morbid events and health care utilization over time. In future research, this information will be used to evaluate the impact of feedback and other intervention tools to improve quality of care for diabetes and cardiovascular disease prevention. PUBLIC HEALTH RELEVANE: This project will directly determine the relationships between the level of adherence by clinical practitioners to evidence-based guidelines and the occurrence of morbidity, mortality, and medical care utilization that result from following various consensus guideline recommendations relating to preventive and management practices among adult patients with diabetes. This information has the potential to evaluate the relative trade- offs between costs and benefits of various guidelines, and to provide powerful motivating information to support adherence to evidence-based guidelines.

描述（由申请人提供）：糖尿病是心血管疾病（CVD）和致残并发症的主要风险因素。虽然大量的修辞和资源都花费在试图防止这些疾病，很少有直接的证据表明，个人的临床实践的变化如何影响糖尿病和心血管疾病风险因素的人的病态和致命的事件和医疗保健费用。该项目将在一个大型综合保健系统登记的16 000名成年糖尿病患者中使用电子病历系统，以确定临床预防和管理的变化与5-10年期间糖尿病和心血管疾病发病轨迹的关系。这项研究的重点是随着时间的推移，在护理管理的从业者水平的变化。该研究将检查风险因素变化（体重、血压、血脂等）。随着时间的推移，并总结这些变化到护理质量指数使用人的时间方法开发的研究人员。疾病管理质量将总结为两个分量表：1）动脉粥样硬化性心血管疾病（ASCVD）预防指数（PI），包括CVD风险和糖尿病并发症风险筛查; 2）CVD和糖尿病风险管理的时间和控制水平（TLC）。然后将这些分量表总结为总体糖尿病-CVD预防指数（DCPI）。该研究将使用实践和患者特征来预测质量指标，以确定预测良好管理的实践、患者和从业人员特征，并确定实践中风险管理质量的变化。最后，该研究将使用质量指标预测5-10年期间的病态和死亡结局。本研究将证明在管理糖尿病和心血管疾病风险方面遵守实践指南的范围（初步数据表明非常广泛），以及随着时间的推移，实践变化与疾病事件和医疗保健利用的关系。在未来的研究中，这些信息将用于评估反馈和其他干预工具的影响，以提高糖尿病和心血管疾病预防的护理质量。公共卫生相关规定：该项目将直接确定临床从业人员对循证指南的依从性水平与发病率、死亡率和医疗利用率之间的关系，这些发病率、死亡率和医疗利用率是由以下与成人糖尿病患者预防和管理实践相关的各种共识指南建议产生的。这些信息有可能评估各种指南的成本和收益之间的相对权衡，并提供强有力的激励信息，以支持遵守循证指南。