VARIATIONS IN THE MANAGEMENT AND OUTCOMES OF DIABETES

我们建议开发一个前瞻性的纵向数据库， 解决医疗有效性问题的特殊要求 II型糖尿病患者目前没有数据库来解决这些问题 充分。与I型糖尿病患者相比， 很明显因此，我们将使用生活质量指标，而不是 长期预防并发症，作为适当的结局指标 用于评估II型糖尿病护理的医疗效果。我们将 研究卫生系统和病人的财务成本， 作为血糖控制和早期发现的效果， 并发症的治疗对患者生活质量的影响。 具体而言，我们建议为 监测II型糖尿病患者的护理成本、质量和结果 糖尿病在三个大型医疗保健提供组织。这些 组织的地理位置和护理系统各不相同， 病人的社会经济地位我们将把利用率和 2型糖尿病患者血糖控制的费用， 以及并发症的检测和治疗，以及与健康有关的 生活质量我们将通过以下方式衡量技术护理的质量： 对指南的遵守和人际护理质量的评估， 病人，利用和支出，以及与健康有关的 生活质量我们将制定指导方针，并确定最佳的技术和 基于文献回顾、决策分析和 随后在数据库中。我们将监测护理相对变化 这些指南以及这种变化对结果的影响。 根据数据库中的信息，我们将开发和测试 旨在改变特定医生行为的干预措施， 利用率和支出，以及技术和人际关系 护理质量。 总而言之，本提案的特点是： 1.由有组织的实践环境认可和支持的数据系统 最大限度地利用日常办公实践的机会 来监控和改善病人护理 2.在原始数据方面具有丰富经验的研究者团队 收集建议用于构建此数据库的类型。 3.使用经过完善和测试的临床结局和病例指标 混合调整 4制定干预措施的指导方针， 改变医生的具体行为 这些功能将使我们能够回答有关 治疗II型糖尿病的有效性，并翻译这些答案 降低医疗成本，提高医疗质量的策略 对于这些患者。

We propose to develop a prospective longitudinal database that is tailored to the special requirements for addressing medical effectiveness questions in Type II diabetes. No database presently exists to address these issues adequately. In contrast to Type I diabetics, blood glucose control is less salient. Therefore we will utilize quality of life measures, not the long-term prevention of complications, as the appropriate outcome measure for assessing medical effectiveness for Type II diabetes care. We will study the financial costs to the health system and to the patient, as well as the effect of blood glucose control and the early detection and treatment of complications on the patients' quality of life. Specifically, we propose to develop a comprehensive database for the monitoring of costs, quality and outcomes of care for patients with Type II diabetes in three large health care delivery organizations. These organizations are diverse in their geography and systems of care as well as the socioeconomic status of their patients. We will relate utilization and expenditures for patients with Type II diabetes to blood glucose control, and the detection and treatment of complications, and to health-related quality of life. We will relate the quality of technical care measured by adherence to guidelines and the quality of interpersonal care assessed by the patient, to utilization and expenditures, as well as health-related quality of life. We will derive guidelines and define optimal technical and interpersonal care based on literature review, decision analyses and subsequently on the database. We will monitor variations in care relative to these guidelines and the impact that this variation has on outcomes. Based on information from the database, we will develop and test interventions designed to change specific physician behaviors with respect to utilization and expenditures, as well as technical and interpersonal quality of care. In summary, this proposal features: 1.A data system endorsed and supported by the organized practice settings themselves, maximizing the opportunity for use in routine office practice to monitor and improve patient care. 2.A team of investigators with considerable experience in primary data collection of the type proposed for construction of this database. 3.Use of well developed and tested measures of clinical outcomes and case mix adjustment. 4 Development of guidelines in the institution of interventions and aimed at changing specific physician behaviors. These features will enable us to answer major questions about the effectiveness of care for Type II diabetes and to translate these answers into strategies that will decrease costs and increase the quality of care for these patients.