Vargas Roberto B, Mangione Carol M, Asch Steven, Keesey Joan, Rosen Mayde, Schonlau Matthias, Keeler Emmett B
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
J Gen Intern Med. 2007 Feb;22(2):215-22. doi: 10.1007/s11606-006-0072-5.
There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.
We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes.
Controlled pre- and postintervention study.
PATIENTS/PARTICIPANTS: Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites.
Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI -3.7%, -0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention.
Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization's settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction.
需要确定有效的实际干预措施，以降低糖尿病患者患心血管疾病的风险。
我们研究参与实施慢性病护理模式（CCM）的协作对降低糖尿病患者心血管疾病风险的影响。
干预前后对照研究。
患者/参与者：在13个接受CCM协作的医疗机构接受护理的糖尿病患者，以及在未接受该协作的医疗机构接受护理的对照组患者。
心血管疾病的10年风险；使用改良的英国前瞻性糖尿病研究风险评估工具进行测定。来自CCM干预组的613例患者和来自常规护理对照组的557例患者符合纳入标准。干预组和对照组的基线心血管疾病10年平均风险均为31%。在观察期内，两组参与者的血压、血脂水平和糖化血红蛋白水平均有所改善。随机截距分层回归模型显示，与对照组相比，干预组未来心血管事件的预测风险降低幅度高2.1%（95%CI -3.7%，-0.5%）。这意味着每48例接受干预的患者中，心血管疾病事件风险会降低一例。
在1年的时间间隔内，这种采用CCM的协作干预降低了在参与机构接受护理的糖尿病患者的心血管疾病风险因素。进一步的工作可以增强这种有前景的多因素干预对降低心血管疾病风险的影响。
