Monitoring Intensification of Treatment for Hyperglycemia and Hyperlipidemia

描述（由申请人提供）：糖尿病护理质量测量越来越多地用于评估质量改进计划以及比较医生和健康计划。因此，重要的是要知道哪些措施与临床结果最相关。最广泛使用的糖尿病护理质量过程测量，A1C和LDL筛查率，有多种局限性。该项目将开发和验证1）一种新的糖尿病护理质量过程测量和2）使用EMR中医生注释文本分析监测该测量的技术。 待制定的新措施：高血糖和高脂血症管理中的强化治疗频率。在之前的工作中，我们成功地开发了一种技术，使我们能够分析医生笔记的文本，以确定抗高血压治疗强化。从这项工作中得出的措施，抗高血压治疗强化的频率，与血压控制密切相关。当前项目的目标是扩展这种创新方法，以开发和验证一种可用于持续测量高血糖和高脂血症治疗强化的技术。血糖和血脂控制减少糖尿病并发症。然而，大多数患者未达到推荐的血糖和LDL水平。为了改善糖尿病患者的护理，越来越多地监测对糖尿病护理的过程措施的遵守。然而，目前使用的过程措施与糖尿病结局改善相关的证据有限。因此，制定与结果密切相关的糖尿病护理过程措施非常重要。越来越多的人认识到，对血压、葡萄糖和LDL控制的贡献是治疗 这些症状在医生就诊期间很少加重。低频率的强化治疗与高血压和A1C的患病率增加有关。此外，旨在增加强化治疗频率的干预措施已被证明可以降低A1C水平。因此，评价高血糖症和高脂血症强化治疗的经验证指标可以作为一种过程测量，为临床医生改善其结局提供有意义的基础。目前确定强化治疗的黄金标准是资源密集型人工记录审查。这阻碍了对强化治疗的广泛衡量。包括医生笔记的计算机化文本的电子病历系统的日益普及为监测治疗强化的新方法提供了机会。在本项目中，我们将扩展我们以前在高血压方面开展的工作，以开发和验证一种技术，该技术可用于糖尿病患者高血糖和高脂血症护理中的持续治疗强化测量。

DESCRIPTION (Provided by the Applicant): Diabetes quality-of-care measurement is increasingly being used to evaluate quality improvement programs and to compare physicians and health plans. It is therefore important to know which measures are best associated with clinical outcomes. The most widely used process measures of diabetes quality-of-care, A1C and LDL screening rates, have multiple limitations. This project will develop and validate 1) a new diabetes quality-of-care process measure and 2) the technology for monitoring that measure using analysis of the text of physician notes in the EMR. New Measure to be Developed: frequency of treatment intensification in the management of hyperglycemia and hyperlipidemia. In prior work we successfully developed a technique that allowed us to analyze the text of physician notes to identify anti-hypertensive treatment intensification. The measure derived from that work, frequency of antihypertensive treatment intensification, was strongly associated with blood pressure control. The objective of the current project is to extend this innovative approach to develop and validate a technique that could be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia. Blood glucose and lipid control reduce diabetes complications. Nevertheless, recommended glucose and LDL levels are not achieved in the majority of patients. To improve care of diabetic patients, adherence to the process measures of diabetes care is increasingly monitored. However, the evidence that the currently used process measures are associated with improvement in diabetes outcomes is limited. It is therefore important to develop process measures of diabetes care that are strongly associated with outcomes. An increasingly recognized contributor to blood pressure, glucose and LDL control is that treatment for these conditions is rarely intensified during physician visits. Low frequency of treatment intensification has been linked to increased prevalence of elevated blood pressure and A1C. Furthermore, interventions aimed at increasing the frequency of treatment intensification have been demonstrated to lower A1C levels. Therefore a validated metric that evaluates intensification of treatment of hyperglycemia and hyperlipidemia could function as a process measure that provides a meaningful basis for clinicians to improve their outcomes. The gold standard for identifying treatment intensification currently is resource-intensive manual record review. This hinders widespread measurement of treatment intensification. Growing prevalence of electronic medical record systems that include computerized text of physician notes provides an opportunity for a novel approach to monitoring treatment intensification. In this project, we will expand the work we previously carried out in hypertension to develop and validate a technique that can be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia in diabetic patients.