Ackermann Ronald T, Thompson Theodore J, Selby Joseph V, Safford Monika M, Stevens Mark, Brown Arleen F, Narayan K M Venkat
Department of Medicine, Indiana University School of Medicine, 250 University Blvd., Suite 122, Indianapolis, IN 46202, USA.
Diabetes Care. 2006 Sep;29(9):2108-13. doi: 10.2337/dc06-0633.
Simple process-of-care indicators are commonly recommended to assess and compare quality of diabetes care across health plans. We sought to determine whether variation in the number of simple diabetes processes of care across provider groups is associated with variation in other quality indicators, including cardiometabolic risk factor levels, patient satisfaction with care, or patient-rated quality of care.
We used cross-sectional survey and chart audit data for 8,733 patients with diabetes who received care from 68 provider groups nested in 10 health plans that participated in the Translating Research Into Action for Diabetes study. Analyses using hierarchical regression models assessed associations of the mean number of seven simple process measures with each of the following: HbA(1c) (A1C), systolic blood pressure (SBP), HDL and LDL cholesterol levels, patient satisfaction with care, and patient-rated quality of care.
After adjusting for case-mix differences across groups and plans, an average of one additional documented process of care for each patient in a group or plan was associated with significantly lower mean LDL cholesterol levels (-4.51 mg/dl [95% CI 1.46-7.58]) but not with A1C, SBP, or HDL cholesterol levels. The number of care processes documented was associated with patient satisfaction measures and self-rated quality of diabetes care.
Variation in the number of simple process-of-care indicators across provider groups or health plans is associated with differences in patient-centered measures of quality, but assessment of the quality of cardiometabolic risk factor control will require more advanced clinical performance indicators.
通常推荐使用简单的医疗过程指标来评估和比较不同健康计划下的糖尿病护理质量。我们试图确定不同医疗服务提供组之间简单糖尿病护理过程数量的差异是否与其他质量指标的差异相关，这些指标包括心血管代谢危险因素水平、患者对护理的满意度或患者自评的护理质量。
我们使用了横断面调查和病历审核数据，这些数据来自8733名糖尿病患者，他们接受了参与“将糖尿病研究转化为行动”研究的10个健康计划中的68个医疗服务提供组的护理。使用分层回归模型进行的分析评估了七种简单过程指标的平均数量与以下各项之间的关联：糖化血红蛋白（HbA1c）、收缩压（SBP）、高密度脂蛋白（HDL）和低密度脂蛋白（LDL）胆固醇水平、患者对护理的满意度以及患者自评的护理质量。
在对不同组和计划之间的病例组合差异进行调整后，一个组或计划中每位患者平均多记录一个护理过程与显著更低的平均低密度脂蛋白胆固醇水平相关（-4.51mg/dl [95%CI 1.46 - 7.58]），但与糖化血红蛋白、收缩压或高密度脂蛋白胆固醇水平无关。记录的护理过程数量与患者满意度指标和糖尿病护理的自评质量相关。
不同医疗服务提供组或健康计划之间简单护理过程指标数量的差异与以患者为中心的质量指标差异相关，但评估心血管代谢危险因素控制的质量将需要更先进的临床绩效指标。
