Bell R A, Camacho F, Goonan K, Duren-Winfield V, Anderson R T, Konen J C, Goff D C
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Am J Prev Med. 2001 Aug;21(2):124-31. doi: 10.1016/s0749-3797(01)00328-2.
Diabetes is a leading cause of death and disability, disproportionately affecting most ethnic minority groups, people of low socioeconomic status, the elderly, and people in rural areas. Despite the availability of evidence-based clinical recommendations, barriers exist in the delivery of appropriate diabetes care. The purpose of this study is to examine the level of diabetes care among low-income populations in North Carolina.
Baseline medical record abstractions were performed (N=429) on diabetic patients at 11 agencies serving low-income populations (community health centers, free clinics, primary care clinics, and public health clinics) across the state participating in a quality-of-diabetes-care initiative. Data were collected for four process (measurement of glycosylated hemoglobin and lipids, dilated eye examination, nephropathy assessment) and two outcome (glycemic and lipid control) measures based on the Diabetes Quality Improvement Project (DQIP) and the Health Plan Employer Data and Information Set (HEDIS), and three additional indicators (blood pressure measurement and control, and lower limb assessment). Compliance rates to individual measures were calculated overall and by demographic and health characteristics.
Diabetes care compliance rates ranged from 77.9% for blood pressure testing to 3.3% for complete foot examinations. Differences in care were observed by age, insulin use, and prevalent disease.
This study indicates low compliance with diabetes care guidelines in underserved North Carolinians, and inconsistency of care according to some demographic and health characteristics. These results stress the need for quality improvement initiatives that enhance the level of care received by patients with diabetes, particularly those most vulnerable to diabetes and its complications.
糖尿病是导致死亡和残疾的主要原因，对大多数少数民族群体、社会经济地位低下的人群、老年人以及农村地区的居民影响尤为严重。尽管有基于证据的临床建议，但在提供适当的糖尿病护理方面仍存在障碍。本研究的目的是调查北卡罗来纳州低收入人群的糖尿病护理水平。
对该州参与糖尿病护理质量倡议的11家为低收入人群服务的机构（社区卫生中心、免费诊所、初级保健诊所和公共卫生诊所）的糖尿病患者进行了基线病历摘要分析（N = 429）。根据糖尿病质量改进项目（DQIP）和健康计划雇主数据与信息集（HEDIS），收集了四个过程指标（糖化血红蛋白和血脂测量、散瞳眼底检查、肾病评估）和两个结果指标（血糖和血脂控制）的数据，以及另外三个指标（血压测量与控制、下肢评估）。总体上以及按人口统计学和健康特征计算了各项指标的依从率。
糖尿病护理依从率从血压检测的77.9%到完整足部检查的3.3%不等。在年龄、胰岛素使用情况和所患疾病方面观察到了护理差异。
本研究表明，在服务不足的北卡罗来纳人中，对糖尿病护理指南的依从性较低，并且在护理方面存在根据某些人口统计学和健康特征的不一致性。这些结果强调了开展质量改进倡议的必要性，以提高糖尿病患者，特别是那些最易患糖尿病及其并发症的患者所接受的护理水平。
