种族、语言、专科护理与糖尿病护理质量。

Ethnicity, language, specialty care, and quality of diabetes care.

作者信息

Nguyen Tung T, Daniels Nicholas A, Gildengorin Ginny L, Pérez-Stable Eliseo J

机构信息

Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California, USA.

出版信息

Ethn Dis. 2007 Winter;17(1):65-71.

PMID:17274212

Abstract

OBJECTIVE

To investigate ethnicity, language, specialty care, and quality of diabetes care in one medical center.

METHODS

Retrospective review of computerized records of patients with diabetes age > or = 50 years who were regularly cared for in general medicine, family practice, or diabetes clinics from 1997 to 2000. Measures of processes of care were tests for creatinine, cholesterol, hemoglobin A1C (HbA1C), and microalbumin; ophthalmologic care; and total visits. Intermediate outcomes were average systolic blood pressure (SBP) < 140 mm Hg and HbA1C < 8%.

RESULTS

Among 1323 patients, test rates for creatinine, cholesterol, microalbuminuria, and HbA1C were 76.6%, 54.7%, 17.2%, 78.8%, respectively. Only 31.0% had ophthalmology visits, 57.4% had SBP < 140 mm Hg, and 62.0% had HbA1C < 8%. In multivariate analyses, African Americans, Asians, and Latinos received more tests and had more total visits than Whites. Intermediate outcomes were similar except that Asians were more likely (odds ratio [OR] = 1.78, 95% confidence interval [CI] 1.26-2.50) to have SBP < 140 mm Hg. Limited English proficient patients had more total visits (7.0) than English speakers (6.5) (P = .01). Compared to patients with only primary care, patients with a diabetes specialist had more microalbuminuria (OR 3.04, 95% CI 1.87-4.95) and HbA1C (OR 1.91, 1.12-3.26) tests, while those with both types of care were more likely to have each of the five process measures but less likely to have HbA1C < 8%.

CONCLUSIONS

Quality of diabetes care was suboptimal for most patients. No ethnic disparity was seen in intermediate outcomes, which may have been achieved through more tests and visits. Combined care by primary and diabetes clinicians may be optimal.

摘要

目的

调查某医学中心糖尿病患者的种族、语言、专科护理及糖尿病护理质量。

方法

回顾性分析1997年至2000年在普通内科、家庭医疗或糖尿病门诊接受定期护理的年龄≥50岁糖尿病患者的计算机记录。护理过程指标包括肌酐、胆固醇、糖化血红蛋白（HbA1C）和微量白蛋白检测；眼科护理；以及总就诊次数。中间结果为平均收缩压（SBP）<140 mmHg和HbA1C<8%。

结果

在1323例患者中，肌酐、胆固醇、微量白蛋白尿和HbA1C的检测率分别为76.6%、54.7%、17.2%、78.8%。仅31.0%的患者接受了眼科检查，57.4%的患者SBP<140 mmHg，62.0%的患者HbA1C<8%。多因素分析显示，非裔美国人、亚裔和拉丁裔比白人接受了更多检测且总就诊次数更多。中间结果相似，但亚裔更有可能（优势比[OR]=1.78，95%置信区间[CI]1.26 - 2.50）使SBP<140 mmHg。英语能力有限的患者总就诊次数（7.0次）多于说英语的患者（6.5次）（P = 0.01）。与仅接受初级护理的患者相比，有糖尿病专科医生的患者进行微量白蛋白尿（OR 3.04，95%CI 1.87 - 4.95）和HbA1C（OR 1.91，1.12 - 3.26）检测的次数更多，而同时接受两种护理的患者更有可能进行五项护理过程指标中的每一项检测，但HbA1C<8%的可能性较小。