AUTOMATED ASSESSMENTS AND THE QUALITY OF DIABETES CARE

门诊病人之间的定期评估可以改善临床决策，特别是当病人面临就诊障碍时。这些评估还可以使卫生保健系统从消费者的角度衡量其提供的服务质量。我们将使用自动电话疾病管理（ATDM）系统检查糖尿病患者以患者为中心的结果的变化，该系统在患者在社区时进行定期评估。我们将从公共医疗保健系统中招募350名患者，从服务于同一地理区域的大型私人管理医疗系统中招募350名患者。每个护理系统的样本将平均分配给主要讲英语和西班牙语的患者，我们将招募相同数量的患者，主要提供者是专家和全科医生。我们将开发ATDM评估工具，包括患者血糖控制、自我护理、健康相关生活质量（HRQL）和护理满意度的测量。这些工具将以广泛使用的具有已知心理测量特性的量表为基础，并将在指南支持的糖尿病护理、以患者为中心的结果测量、卫生保健绩效监测和病例组合调整方面的专家小组的投入下开发。患者将接受为期一年的每周ATDM评估，其他数据将通过季度患者调查、病历回顾、糖化血红蛋白（HgA1c）检测和电子使用数据库收集。我们将使用一致性测量方法评估患者ATDM报告的可靠性和有效性，以及数据与使用其他方法收集的同期信息的证实程度。我们将开发统计模型，以衡量ATDM报告在多大程度上改善了对健康结果的预测（例如，HgA1c），而不仅仅局限于门诊医生通常可以获得的数据。最后，我们将检查跨护理系统和提供者专业的atdm报告结果的病例混合调整差异，并将探讨治疗过程对这些差异的贡献。总之，本研究将确定ATDM评估系统是否是一种实用的策略，用于监测大量糖尿病患者的健康状况，并规避诸如缺乏语言适当护理等获取障碍。我们还将使用评估作为一种以患者为中心的测量门诊护理质量的方法，由于收集此类信息的难度和费用，质量评估的一个维度一直被低估。

Regular patient assessments between outpatient encounters could improve clinical decision-making, particularly when patients face access barriers. These assessments also could allow health care systems to measure the quality of services they deliver from a consumer perspective. We will examine variation in patient-centered outcomes for patients with diabetes using an automated telephone disease management (ATDM) system that conducts periodic assessments while patients are in the community. We will enroll 350 patients from a public health care system and 350 patients from a large private managed care system serving the same geographic region. Samples in each system of care will be divided equally between primarily English-speaking and Spanish-speaking patients, and we will enroll equal numbers of patients with primary providers who are specialists and general practitioners. We will develop ATDM assessment instruments that include measures of patients' glycemic control, self-care, health-related quality of life (HRQL), and satisfaction with care. These instruments will be based on widely-used scales with known psychometric properties and will be developed with input from a panel of experts in guidelines-supported diabetes care, the measurement of patient-centered outcomes, health care performance monitoring, and case mix adjustment. Patients will receive weekly ATDM assessments for one year, and other data will be collected via quarterly patient surveys, medical record reviews, glycosylated hemoglobin (HgA1c) testing, and electronic utilization databases. We will evaluate the reliability and validity of patients' ATDM reports using measures of consistency and the extent to which the data corroborate contemporaneous information collected using other methods. We will develop statistical models that measure the extent to which the ATDM reports improve the prediction of health outcomes (e.g., HgA1c) beyond what is possible when limited to data that is typically available to ambulatory care physicians. Finally, we will examine case mix-adjusted differences in ATDM-reported outcomes across systems of care and provider specialties and will explore the contribution of treatment processes to these differences. In summary, this study will determine whether an ATDM assessment system is a pragmatic strategy for monitoring the health of large panels of patients with diabetes and circumventing access barriers such as the absence of language-appropriate care. We also will use the assessments as a patient-centered method of measuring the quality of ambulatory care, a dimension of quality assessment that has been under-emphasized due to the difficulty and expense of gathering such information.