Renders C M, Valk G D, Franse L V, Schellevis F G, van Eijk J T, van der Wal G
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam.
Diabetes Care. 2001 Aug;24(8):1365-70. doi: 10.2337/diacare.24.8.1365.
To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes.
A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA(1c) and blood lipid levels. Main patient outcomes were blood pressure and HbA(1c) and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices.
Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01-5.82) for the measurement of urine albumin to 12.08 (4.70-31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome.
The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.
评估一项质量改进计划对糖尿病患者所接受护理及患者结局的长期有效性。
对干预组的312例2型糖尿病患者和参照组的77例2型糖尿病患者进行了一项非随机试验。随访期为42个月。质量改进计划侧重于改善糖尿病护理的提供情况及患者结局。该计划包括临床实践指南、研究生教育、审核与反馈、糖尿病护理登记模板以及召回系统。从医疗记录中提取有关所提供护理的数据。护理提供方面的主要结局为患者年度就诊次数、血压、糖化血红蛋白（HbA1c）及血脂水平。主要患者结局为血压、糖化血红蛋白及血脂水平。采用多水平分析来调整同一患者内重复观察值之间的相关性以及一般诊疗机构内患者的聚集性。
干预组患者接受的护理远比参照组患者更符合指南要求。比值比范围从尿白蛋白测量的2.43（95%可信区间1.01 - 5.82）到血压测量的12.08（4.70 - 31.01）。未发现对任何患者结局有有益影响。
质量改进计划改善了糖尿病护理的提供情况，但对患者结局未产生任何影响。
