Giorda C, Petrelli A, Gnavi R
Metabolism and Diabetes Unit ASL 8, Regione Piemonte, Chieri (To), Italy.
Diabet Med. 2006 Apr;23(4):377-83. doi: 10.1111/j.1464-5491.2006.01851.x.
We evaluated whether differences in the use of specialized care have an impact on rates of hospitalization for diabetes.
In 2001 we determined the number of hours of second-level diabetes care provided by local health units (LHU) of the Piemonte Region (Italy) and created an indicator of the mean weekly number of hours of care per 1000 residents for each LHU. From the database of the Piemonte Hospital Information System, we extracted all hospitalizations for 20-75-year-old residents with a main discharge diagnosis of diabetes mellitus (n = 3457). For each LHU, we calculated the hospitalization rate, the percentage of unplanned hospital admissions, the mean length of hospital stay, the percentage of day-hospital admissions and the percentage of re-admissions for diabetes-related complications within 6 months. The association between the indicators of specialized care and of hospital care was studied using two-level generalized hierarchical linear regression models (level 1: patient; level 2: LHU), taking into account the clustered nature of the data. Age, educational level and an indicator of disease severity were used as adjustment parameters.
In the tertile of LHUs that provided the greatest number of hours of diabetes care, we observed, compared with the lowest tertile fewer unplanned hospital admissions [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.20-0.67], greater day-hospital use (OR 1.99; 0.72-5.49) and a lower mean duration of hospital stay (coefficient -0.26; 95% CI -0.45 to -0.06), independently of the socio-economic level, which was a separate risk factor.
The intensity of specialized diabetes care greatly influences the characteristics of hospitalization.
我们评估了专科护理使用方面的差异是否会对糖尿病住院率产生影响。
2001年，我们确定了意大利皮埃蒙特地区地方卫生单位（LHU）提供的二级糖尿病护理小时数，并为每个LHU创建了每1000名居民每周平均护理小时数的指标。从皮埃蒙特医院信息系统数据库中，我们提取了所有主要出院诊断为糖尿病的20至75岁居民的住院信息（n = 3457）。对于每个LHU，我们计算了住院率、非计划住院百分比、平均住院时间、日间医院住院百分比以及6个月内糖尿病相关并发症再入院百分比。使用二级广义分层线性回归模型（第1级：患者；第2级：LHU）研究专科护理指标与医院护理指标之间的关联，同时考虑数据的聚类性质。年龄、教育水平和疾病严重程度指标用作调整参数。
在提供糖尿病护理小时数最多的LHU三分位数中，与最低三分位数相比，我们观察到非计划住院次数更少[优势比（OR）0.37；95%置信区间（CI）0.20 - 0.67]，日间医院使用率更高（OR 1.99；0.72 - 5.49），平均住院时间更短（系数 -0.26；95% CI -0.45至 -0.06），且独立于社会经济水平，社会经济水平是一个单独的风险因素。
专科糖尿病护理的强度对住院特征有很大影响。
