AUTOMATED ASSESSMENTS AND THE QUALITY OF DIABETES CARE

门诊之间定期的患者评估可以改善临床决策，特别是在患者面临准入障碍的情况下。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。我们将从公共医疗系统招收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招收350名患者。每个医疗系统的样本将在主要说英语和说西班牙语的患者之间平均分配，我们将招收同等数量的初级提供者的患者，他们是专科医生和全科医生。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。这些工具将基于广泛使用的量表，具有已知的心理测量学特性，并将与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意见一起开发。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、病历审查、糖化血红蛋白(HgA1c)测试和电子利用数据库收集。我们将使用一致性的衡量标准来评估患者ATDM报告的可靠性和有效性，以及这些数据在多大程度上证实了使用其他方法收集的同期信息。我们将开发统计模型，以衡量ATDM报告在多大程度上改善了健康结果的预测(例如，HgA1c)，超出了仅限于门诊护理医生通常可用的数据时的可能。最后，我们将检查病例组合调整后的ATDM报告的结果在护理系统和提供者专科之间的差异，并将探索治疗过程对这些差异的贡献。总之，这项研究将确定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，并绕过获取障碍，如缺乏语言适当的护理。我们还将使用评估作为一种以患者为中心的方法来衡量门诊护理的质量，这是质量评估的一个方面，由于收集此类信息的困难和费用，一直没有得到重视。

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.