Association Between Quality of Care for Diabetes and Medically Complex Conditions

描述（由申请人提供）：目的：研究糖尿病患者医学上复杂合并症的存在与接受高质量预防保健之间的关系。背景：对于糖尿病患者，高质量的护理包括接受预防性服务。研究人员检查了与接受糖尿病预防服务相关的患者和提供者特征。然而，尽管糖尿病患者的合并症发病率很高，但对于接受预防性服务是否与需要复杂护理的慢性合并症有关，人们知之甚少。方法：本研究将分析2000-2002年医疗支出小组调查的横断面和纵向数据，这是一项对美国平民非机构人口的全国代表性调查。研究人群年龄在18岁以上，患有糖尿病，并完成了疾病治疗和严重程度的调查。因变量将以自我报告的预防性服务接收情况为基础。主要的自变量是是否存在医学上的复杂疾病，即在人群中普遍存在的慢性病，专家小组认为需要复杂的治疗。控制变量将包括易感性、使能性和需求特征。第一个研究假设是，在糖尿病患者中，在调整了易感因素、使能因素和需要特征后，具有高度医疗复杂性的慢性合并症与未接受糖尿病预防服务有关。第二个研究假设是，在糖尿病患者中，在调整了易感因素、使能因素和需要特征后，具有高水平医疗复杂性的慢性合并症与2年内持续低质量的预防保健有关。意义：本研究将有助于更好地理解为糖尿病患者和复杂的医学合并症患者提供高质量护理所面临的挑战，从而解决健康人群公共卫生服务2010年目标和医疗保健研究与质量机构提高护理质量的使命，特别是对需要慢性医疗保健的人。

DESCRIPTION (provided by the applicant): Objective: To examine the association between the presence of medically complex comorbidities and the receipt of high-quality preventive care in persons with diabetes. Background: For persons with diabetes, high-quality care includes receipt of preventive services. Researchers have examined patient and provider characteristics associated with the receipt of preventive services for diabetes. However, despite the high prevalence of comorbidities among people with diabetes, little is known about whether receipt of preventive services is associated with chronic comorbidities that require complex care. Methods: This study will analyze cross-sectional and longitudinal data from the 2000-2002 Medical Expenditure Panel Survey, a nationally representative survey of the U.S. civilian, noninstitutionalized population. The study population was over the age of 18, had diabetes, and completed a survey on disease treatment and severity. The dependent variables will be based on self-reported receipt of preventive services. The main independent variable will be the presence of medically complex conditions, which are chronic conditions that are prevalent in the population and that an expert panel identifies as requiring complex treatment. Control variables will include predisposing, enabling, and need characteristics. The first study hypothesis is that among persons with diabetes, chronic comorbidities that have a high level of medical complexity are associated with not receiving preventive services for diabetes mellitus, after adjusting for predisposing, enabling, and need characteristics. The second study hypothesis is that among persons with diabetes, chronic comorbidities that have a high level of medical complexity are associated with consistently low quality of preventive care over a 2-year period, after adjusting for predisposing, enabling, and need characteristics. Significance: This study will provide greater understanding of the challenges of providing high-quality care to persons with diabetes and medically complex comorbidities, thus addressing the Public Health Service's of Healthy People 2010 goals and the Agency for Healthcare Research and Quality's mission of improving quality of care, particularly for persons needing chronic health care.