VARIATIONS IN THE MANAGEMENT AND OUTCOMES OF DIABETES

我们建议开发一个量身定做的前瞻性纵向数据库 关于解决医疗效果问题的特殊要求 在II型糖尿病中。目前还没有解决这些问题的数据库 足够了。与I型糖尿病患者相比，血糖控制较少 很突出。因此，我们将使用生活质量衡量标准，而不是 长期预防并发症，作为适当的结果衡量标准 用于评估II型糖尿病护理的医疗效果。我们会 还要研究医疗系统和患者的财务成本 由于控制血糖的效果和及早发现和 并发症的处理对患者生活质量的影响。 具体来说，我们建议发展一个全面的资料库，以供 监测II型患者的护理成本、质量和结果 糖尿病在三个大型医疗保健提供机构。这些 组织在其地理位置、护理系统以及 他们病人的社会经济地位。我们将把利用率和 2型糖尿病患者用于血糖控制的支出， 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来衡量技术护理的质量 对指南的遵守情况和人际关系护理质量的评估 对患者的利用和支出，以及与健康相关的 生活质量。我们将制定指导方针并定义最佳的技术和 基于文献回顾、决策分析和研究的人际关系护理 随后在数据库上。我们将监测护理相关人员的变化 这些指导方针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 旨在改变特定医生尊重行为的干预措施 使用和支出，以及技术和人际关系 护理质量。 综上所述，这项建议的特点是： 1.有组织的练习环境认可和支持的数据系统 自身，最大限度地增加在日常办公实践中使用的机会 监督和改善病人护理。 2.一支在原始数据方面拥有丰富经验的调查团队 建议用于构建此数据库的类型的集合。 3.使用经过充分开发和测试的临床结果和病例测量方法 混合调整。 4制定干预措施和目标的指导方针 在改变特定的医生行为方面。 这些功能将使我们能够回答有关 II型糖尿病护理的有效性和翻译这些答案 转变为降低成本和提高护理质量的战略 对这些病人来说。

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.