Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data
Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data
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DOI：
10.1016/j.diabres.2019.02.001
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发表时间：
2019-03-01
影响因子：
5.1
通讯作者：
Ohsugi, Mitsuru
中科院分区：
文献类型：
--
作者：
Tanaka, Hirokazu;Sugiyama, Takehiro;Ohsugi, Mitsuru
目的：评估近十年来日本糖尿病护理过程测量质量指标的时间变化。方法：利用2006年4月至2016年3月日本医疗数据中心提供的健康保险理赔数据进行五重重复横断面研究。我们确定了46631名接受抗糖尿病药物治疗的门诊患者，他们至少每三个月定期去医院或诊所一次。我们评估了与血糖控制监测、血脂监测、视网膜病变筛查、肾病筛查和适当的药物选择有关的质量指标。采用多元协变量调整的广义估计方程（GEE）模型，按观察期、降糖药物类型或设施类型估计接受适当检查/处方的患者比例。结果：2007 - 2015年，适当的药物选择和肾病筛查的质量指标值有所提高，而血糖控制监测和视网膜病变筛查的质量指标值仍处于次优状态。在大医院开处方的患者更有可能接受推荐的检查(例如，2015年，诊所的视网膜病变筛查比例为36.1% (95% CI: 35.4-36.7%)，小医院为40.6% (95% CI: 39.1-42.2%)，大医院为46.0% （95% CI: 44.8-47.2%）。结论：在日本，糖尿病护理的几个过程措施仍然不够理想。(C) 2019作者。Elsevier B.V.出版
Aim: To assess the temporal changes in the quality indicators pertaining to the process measures of diabetes care during a recent decade in Japan.Methods: A five-fold repeated cross-sectional study was conducted using health insurance claims data provided by the Japan Medical Data Center between April 2006 and March 2016. We identified 46,631 outpatients with antidiabetic medication who regularly visited hospitals or clinics at least every three months. We evaluated the quality indicators pertaining to glycemic control monitoring, lipid profile monitoring, retinopathy screening, nephropathy screening, and appropriate medication choice. The proportions of patients who received appropriate examinations/prescriptions, by observation period and either the type of antidiabetic medication or facility type were estimated using generalized estimating equation (GEE) models with multiple covariate adjustments.Results: The quality indicator values for appropriate medication choice and nephropathy screening improved between 2007 and 2015, whereas those for glycemic control monitoring and retinopathy screening remained suboptimal. Patients prescribed medications in larger hospitals were likelier to undergo the recommended examinations (e.g. retinopathy screening: 36.1% (95% CI: 35.4-36.7%) for clinic, 40.6% (95% CI: 39.1-42.2%) for smaller hospital, and 46.0% (95% CI: 44.8-47.2%) for larger hospital in 2015).Conclusions: Several process measures of diabetes care remained suboptimal in Japan. (C) 2019 The Authors. Published by Elsevier B.V.