Schachter Kenneth A, Cohen Stuart J
Mel and Enid Zuckerman Arizona College of Public Health, Tucson, AZ 85719, USA.
Prev Chronic Dis. 2005 Jan;2(1):A17. Epub 2004 Dec 15.
Given the dramatic increase in type 2 diabetes in the United States, the development of effective strategies to prevent and control this potentially devastating illness is more important than ever. In the Southwest, diabetes is a far too common and rapidly growing problem among Mexican Americans living near the U.S.-Mexico border. A project designed to address this problem enabled faculty from the University of Arizona to work with community health centers to evaluate and improve diabetes care in border communities.
This project was a component of the Border Health Strategic Initiative (Border Health iSI!) and Racial and Ethnic Approaches to Community Health 2010 (REACH 2010), both funded by the Centers for Disease Control and Prevention. University of Arizona faculty worked in partnership with five community health centers funded by the Health Resources and Services Administration. The goal of the faculty was to assist the community health centers with 1) development of measures of diabetes care based on national clinical practice guidelines, 2) identification of gaps in care based on those measures, and 3) implementation of strategies for closing those gaps.
All five centers prioritized their top four or five indicators of diabetes care (e.g., annual dilated eye examination). Different community health centers selected different indicators. Baseline medical record audits were performed using the chosen indicators. Individual results were shared confidentially with providers; overall center results were shared and discussed with providers and staff.
Each clinic chose its own strategies for closing gaps in care. At one-year follow-up, there was evidence of improvement for the majority of indicators in all community health centers. However, some gaps remained. Of the three community health centers having a second-year evaluation, two maintained or increased the improvements made, but one lost ground.
Our experience with these five border clinics was that translating guidelines into practice is easier said than done. Factors that favored success included an onsite champion, staff buy-in, a willingness to see systems change, and the availability of additional resources, particularly for chart reviews.
鉴于美国2型糖尿病患者数量急剧增加，制定有效策略来预防和控制这种可能具有毁灭性的疾病比以往任何时候都更加重要。在西南部，糖尿病在美墨边境附近居住的墨西哥裔美国人中是一个极为常见且迅速蔓延的问题。一个旨在解决这一问题的项目使亚利桑那大学的教员能够与社区健康中心合作，评估并改善边境社区的糖尿病护理。
该项目是边境健康战略倡议（边境健康iSI!）和2010年社区健康的种族和族裔方法（REACH 2010）的组成部分，这两个项目均由疾病控制与预防中心资助。亚利桑那大学的教员与由卫生资源和服务管理局资助的五个社区健康中心合作。教员的目标是协助社区健康中心：1）根据国家临床实践指南制定糖尿病护理衡量标准；2）根据这些标准找出护理差距；3）实施缩小这些差距的策略。
所有五个中心都将其糖尿病护理的前四或五项指标列为优先事项（例如年度散瞳眼科检查）。不同的社区健康中心选择了不同的指标。使用选定的指标进行基线病历审核。个人结果会保密地与提供者分享；中心的总体结果会与提供者和工作人员分享并进行讨论。
每个诊所都选择了自己缩小护理差距的策略。在一年的随访中，所有社区健康中心的大多数指标都有改善的迹象。然而，一些差距仍然存在。在接受第二年评估的三个社区健康中心中，有两个维持或加大了所取得的改善，但有一个出现了倒退。
我们在这五个边境诊所的经验表明，将指南转化为实践说起来容易做起来难。有利于成功的因素包括有现场倡导者、工作人员的认同、愿意看到系统变革以及有额外资源可用，特别是用于图表审查的资源。
