Improving Diabetes Quality Reports for Persons with Multiple Chronic Conditions

描述（由申请人提供）：在美国，大多数医疗保健利用决策是由约27%的患有多种慢性病的美国人做出的，占所有医疗保健支出的66%。总体而言，人们越来越认识到，现有的医疗保健提供者质量的公共报告不支持这些人的决策。特别是，糖尿病患者的报告可能具有误导性，因为绝大多数糖尿病患者至少有一种其他慢性疾病，大多数人还有其他几种可能影响治疗优先级或改变护理目标的疾病。我们的主要目标是检查并最终支持改善糖尿病和多种慢性病患者对提供者质量公开报告的使用。具体来说，我们的目标包括：（1）定义和确定具有类似慢性疾病模式的糖尿病患者的不同集群的患病率，（2）检查糖尿病质量指标是否满足按条件集群分层后的最小样本量要求，并探索由此产生的变化。 提供者的表现，（3）探索糖尿病患者的护理碎片化程度，重点是在按病情聚类分层后，护理分散在初级和专科提供者和诊所之间的程度，以及（4）获得消费者对按病情聚类分层糖尿病质量指标和专家就诊的有用性的反馈。我们与威斯康星州医疗质量合作组织合作，该组织是一个提供者团体联盟，在门诊护理公共报告方面处于全国领先地位。对于目标1-3，参与协作的三个多专业提供者团体将提供来自其电子健康记录的数据，共计约52，000名糖尿病患者。在一种创新的方法中，我们将使用潜在类别分析来识别具有类似慢性疾病模式的不同人群，然后使用这些疾病集群来创建具有类似慢性疾病的个人亚组，并检查（在这些亚组中）糖尿病质量指标的表现以及护理分散在初级和专科护理提供者和诊所中的程度。我们还将开发交互式网页，以显示糖尿病质量指标和访问专家为每个单独的用户根据其集群的条件，建设合作的消费者网站。最后，我们对约20名糖尿病患者或护理糖尿病患者的人进行认知访谈，以获得消费者对这些信息的有用性和附加值的反馈。拟议的研究的主要优势包括我们的研究和国家认可的传播合作伙伴之间的直接联系，我们以前与他们成功的合作伙伴关系活动，从威斯康星州的各种初级保健诊所广泛的数据采集，使用一套完善的糖尿病质量定义，并使用定量和定性研究方法。拟议的研究将提供必要的信息，以了解如何改善对患有多种慢性病的人的提供者质量的公共报告。

DESCRIPTION (provided by applicant): The majority of health care utilization decisions in the US are made by the ~27% of Americans with multiple chronic conditions, comprising 66% of all healthcare spending. Overall, it is increasingly recognized that existing public reports of healthcare provider quality do not support decision making for these persons. In particular, reports for persons with diabetes may be misleading as the large majority of persons with diabetes have at least one other chronic condition and most have several other conditions that may influence decisions about treatment priorities or alter the goals of care. Our primary goal is to examine and ultimately support improvement in the use of public reports of provider quality by persons with diabetes and multiple chronic conditions. Specifically, our aims include: (1) define and determine the prevalence of distinct clusters of persons with diabetes who have similar patterns of chronic conditions, (2) examine whether diabetes quality metrics meet minimum sample size requirements after stratifying by condition cluster, and explore resulting variation in provider performance, (3) explore the extent of care fragmentation for persons with diabetes, focusing on the extent to which care is dispersed among primary and specialty providers and clinics after stratifying by condition cluster, and (4) obtain consumer feedback on the usefulness of stratifying diabetes quality metrics and visits to specialists by condition cluster. We partner with the Wisconsin Collaborative for Healthcare Quality, a consortium of provider groups that is a national leader in the public reporting on ambulatory care. For Aims 1-3, three multi-specialty provider groups participating in the Collaborative will provide data from their electronic health records for a total of ~52,000 persons with diabetes. In an innovative approach, we will use latent class analysis to identify distinct clusters of persons with similar patterns of chronic conditions, then use these condition clusters to create subgroups of individuals with similar chronic conditions, and examine (within these subgroups) performance on diabetes quality metrics and the extent to which care is dispersed among primary and specialty care providers and clinics. We will also develop interactive web pages to display diabetes quality metrics and visits to specialists for each individual user according to their cluster of conditions, building o the Collaborative's consumer web site. Finally, we conduct cognitive interviews with ~20 persons with diabetes or persons who care for someone with diabetes to obtain consumer feedback on the usefulness and added value of this information. Major advantages of the proposed study include a direct tie between our research and a nationally-recognized dissemination partner with whom we have previous successful partnership activities, the acquisition of data from a broad range of diverse primary care clinics across the state of Wisconsin, use of a set of well-established definitions for diabetes quality, and use of both quantitative and qualitative research approaches. The proposed research will provide information essential to understanding how to improve public reports on provider quality for persons with multiple chronic conditions.