Ward Marcia M, Yankey Jon W, Vaughn Thomas E, BootsMiller Bonnie J, Flach Stephen D, Welke Karl F, Pendergast Jane F, Perlin Jonathan, Doebbeling Bradley N
Department of Health Management and Policy, University of Iowa, Iowa City, Iowa 52242-1008, USA.
Med Care. 2004 Sep;42(9):840-50. doi: 10.1097/01.mlr.0000135809.92048.d9.
Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes.
To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes.
Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers.
We sampled 109 Veterans Affairs medical centers (VAMCs).
Analyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients.
Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.
最佳糖尿病管理依赖于医疗服务提供者在护理过程中遵循循证实践指南，以及患者遵循自我管理建议，以实现患者预后最大化。
探讨：（1）医疗服务提供者遵循指南的程度；（2）糖尿病患者的血糖、血脂和血压控制程度；（3）组织和患者群体特征在影响医疗服务提供者对糖尿病的遵循情况及患者预后指标方面的作用。
对图表审查中的医疗服务提供者遵循情况和患者预后指标进行二次数据分析，并对机构质量管理人员进行调查。
我们抽取了109家退伍军人事务医疗中心（VAMC）。
分析表明，退伍军人事务医疗中心的医疗服务提供者对糖尿病指南（即糖化血红蛋白、足部、眼部、肾脏和血脂筛查）的遵循情况以及患者预后指标（即血糖、血脂和高血压控制以及吸烟状况）与其他地方报告的情况相当或更好。医疗服务提供者对糖尿病指南遵循程度较高的退伍军人事务医疗中心具有显著的组织特征，包括更频繁的糖尿病护理质量反馈、指定指南倡导者、及时实施护理质量改进措施以及对指南适用性的更高接受度。糖尿病患者预后指标较好的退伍军人事务医疗中心，医生和护士之间的沟通更有效，通过教育项目和全院大查房报告来实施糖尿病指南，并且总体患者群体年龄较大，黑人患者比例较小。
医疗保健组织可以采用许多已确定的组织特征来加强其机构内的护理服务。
