在全科医疗中实施糖尿病治疗临床指南。对与基于计算机的决策支持系统实施相关的努力、过程和患者结局进行评估。

Implementing clinical guidelines in the treatment of diabetes mellitus in general practice. Evaluation of effort, process, and patient outcome related to implementation of a computer-based decision support system.

作者信息

Hetlevik I, Holmen J, Krüger O, Kristensen P, Iversen H, Furuseth K

机构信息

National Institute of Public Health, Ranheim Health Center.

出版信息

Int J Technol Assess Health Care. 2000 Winter;16(1):210-27. doi: 10.1017/s0266462300161185.

DOI:10.1017/s0266462300161185

PMID:10815366

Abstract

OBJECTIVES

To evaluate the implementation of clinical guidelines for diabetes mellitus in general practice with a specific computer-based clinical decision support system (CDSS) as part of the intervention.

METHODS

Randomized study with health center as unit. General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. Seventeen health centers with 24 doctors and 499 patients with diabetes mellitus were in the intervention group and 12 health centers with 29 doctors and 535 patients were in the control group. Main outcome measures were group differences in fractions of patients without registrations (process evaluation) and mean group differences for the same variables (patient outcome evaluation).

RESULTS

Statistically significant group differences were experienced for fractions of patients without registration of cigarette smoking (intervention group, 82.6%; control group 94.5%), body mass index (78.2% vs. 93.0%), and sufficient registrations for calculation of risk score for myocardial infarction (91.1% vs. 98.3%); all during 18 months. Large center variations were shown for all variables. The only statistically significant group difference was -2.3 mm Hg (95% CI, -3.8, -0.8) in diastolic blood pressure in favor of the intervention group. Statistically insignificant differences in favor of the intervention group were HbA1c, -0.1% (95% CI, -0.4, 0.1), systolic blood pressure, -1.2 mm Hg (95% CI, -4.4, 2.0). Statistically insignificant differences in favor of the control group were fractions of smokers, +3.0% (95% CI, -4.0, 10.0), body mass index, +0.3 kg/m2 (95% CI, -0.8, 1.4), risk score in female +0.1 (95% CI, -5.1, 5.2), and risk score in male +2.6 (95% CI, -14.2, 19.5).

CONCLUSIONS

Implementation of clinical guidelines for diabetes mellitus in general practice, by means of a CDSS and several procedures for implementation, did not result in a clinically significant change in doctors' behavior or in patient outcome.

摘要

目的

以特定的基于计算机的临床决策支持系统（CDSS）作为干预措施的一部分，评估糖尿病临床指南在全科医疗中的实施情况。

方法

以健康中心为单位进行随机研究。研究对象为挪威南特伦德拉格郡和北特伦德拉格郡的全科医疗，当地居民达38万。干预组有17个健康中心，24名医生和499名糖尿病患者；对照组有12个健康中心，29名医生和535名患者。主要结局指标为未登记患者比例的组间差异（过程评估）以及相同变量的平均组间差异（患者结局评估）。

结果

在18个月期间，干预组和对照组在以下方面存在统计学显著差异：吸烟未登记患者比例（干预组82.6%；对照组94.5%）、体重指数（78.2%对93.0%）以及心肌梗死风险评分的充分登记情况（91.1%对98.3%）。所有变量均显示出较大的中心差异。唯一具有统计学显著意义的组间差异是舒张压方面，干预组比对照组低2.3 mmHg（95%可信区间，-3.8，-0.8）。干预组在糖化血红蛋白方面有统计学不显著的差异，降低了-0.1%（95%可信区间，-0.4，0.1），收缩压降低了-1.2 mmHg（95%可信区间，-4.4，2.0）。对照组在以下方面有统计学不显著的差异：吸烟者比例增加3.0%（95%可信区间，-4.0，10.0），体重指数增加0.3 kg/m²（95%可信区间，-0.8，1.4），女性风险评分增加0.1（95%可信区间，-5.1，5.2），男性风险评分增加2.6（95%可信区间，-14.2，19.5）。