Wagner E H, Grothaus L C, Sandhu N, Galvin M S, McGregor M, Artz K, Coleman E A
W.A. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101, USA.
Diabetes Care. 2001 Apr;24(4):695-700. doi: 10.2337/diacare.24.4.695.
To evaluate the impact of primary care group visits (chronic care clinics) on the process and outcome of care for diabetic patients.
We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff model health maintenance organization (HMO). Patients included diabetic patients > or = 30 years of age in each participating primary care practice, selected at random from an automated diabetes registry. Primary care practices were randomized within clinics to either a chronic care clinic (intervention) group or a usual care (control) group. The intervention group conducted periodic one-half day chronic care clinics for groups of approximately 8 diabetic patients in their respective doctor's practice. Chronic care clinics consisted of standardized assessments; visits with the primary care physician, nurse, and clinical pharmacist; and a group education/peer support meeting. We collected self-report questionnaires from patients and data from administrative systems. The questionnaires were mailed, and telephoned interviews were conducted for nonrespondents, at baseline and at 12 and 24 months; we queried the process of care received, the satisfaction with care, and the health status of each patient. Serum cholesterol and HbA1c levels and health care use and cost data was collected from HMO administrative systems.
In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive procedures and helpful patient education. Of five primary health status indicators examined, two (SF-36 general health and bed disability days) were significantly better in the intervention group. Compared with control patients, intervention patients had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants, we found consistently positive associations between the number of chronic care clinics attended and a number of outcomes, including patient satisfaction and HbA1c levels.
Periodic primary care sessions organized to meet the complex needs of diabetic patients imrproved the process of diabetes care and were associated with better outcomes.
评估初级保健小组就诊（慢性病诊所）对糖尿病患者护理过程及结果的影响。
在一个大型员工模式健康维护组织（HMO）中，我们对随机分为干预组和对照组的初级保健机构中的干预措施进行了评估。患者包括各参与初级保健机构中年龄≥30岁的糖尿病患者，从自动化糖尿病登记系统中随机选取。初级保健机构在诊所内随机分为慢性病诊所（干预）组或常规护理（对照）组。干预组在各自医生的诊所为约8名糖尿病患者组成的小组定期开展为期半天的慢性病诊所服务。慢性病诊所包括标准化评估；与初级保健医生、护士及临床药剂师的就诊；以及小组教育/同伴支持会议。我们收集了患者的自我报告问卷及行政系统的数据。问卷通过邮寄发放，对未回复者在基线、12个月和24个月时进行电话访谈；我们询问了所接受护理的过程、对护理的满意度以及每位患者的健康状况。血清胆固醇和糖化血红蛋白（HbA1c）水平以及医疗保健使用和费用数据从HMO行政系统中收集。
在24个月的意向性分析中，干预组接受了显著更多的推荐预防性程序和有益的患者教育。在所检查的五项主要健康状况指标中，有两项（SF - 36总体健康和卧床残疾天数）在干预组中显著更好。与对照患者相比，干预患者的初级保健就诊次数略多，但专科和急诊室就诊次数显著更少。在干预参与者中，我们发现参加慢性病诊所的次数与许多结果之间始终存在正相关，包括患者满意度和HbA1c水平。
为满足糖尿病患者复杂需求而组织的定期初级保健服务改善了糖尿病护理过程，并与更好的结果相关。
