糖尿病管理中的风险评估：全科医生如何评估糖尿病所致风险？
Risk assessment in diabetes management: how do general practitioners estimate risks due to diabetes?
作者信息
Häussler Bertram, Fischer Gisela C, Meyer Sibylle, Sturm Diethard
机构信息
Institut für Gesundheits- und Sozialforschung, Berlin, Germany.
出版信息
Qual Saf Health Care. 2007 Jun;16(3):208-12. doi: 10.1136/qshc.2006.019539.
OBJECTIVES
To evaluate the ability of general practitioners (GPs) in Germany to estimate the risk of patients with diabetes developing complications.
METHODS
An interview study using a structured questionnaire to estimate risks of four case vignettes having diabetes-specific complications within the next 10 years, risk reduction and life expectancy potential. A representative random sample of 584 GPs has been drawn, of which 150 could be interviewed. We compared GPs' estimates among each other (intraclass correlation coefficient (ICC) and Cohen's (multirater-) kappa) and with risks for long-term complications generated by the multifactor disease model "Mellibase", which is a knowledge-based support system for medical decision management.
RESULTS
The risk estimates by GPs varied widely (ICC 0.21 95% CI (0.13 to 0.36)). The average level of potential risk reduction was between 47% and 70%. Compared with Mellibase values, on average, the GPs overestimated the risk threefold. Mean estimates of potential prolongation of life expectancy were close to 10 years for each patient, whereas the Mellibase calculations ranged from 3 to 10 years.
CONCLUSIONS
Overestimation could lead to unnecessary care and waste of resources.
目的
评估德国全科医生（GP）对糖尿病患者发生并发症风险的评估能力。
方法
采用结构化问卷进行访谈研究，以评估四个病例 vignette 在未来 10 年内发生糖尿病特异性并发症的风险、风险降低情况和预期寿命潜力。抽取了 584 名全科医生的代表性随机样本，其中 150 名接受了访谈。我们比较了全科医生之间的评估结果（组内相关系数（ICC）和科恩（多评估者）kappa），并与多因素疾病模型“Mellibase”生成的长期并发症风险进行了比较，“Mellibase”是一个基于知识的医疗决策管理支持系统。
结果
全科医生的风险评估差异很大（ICC 0.21，95%可信区间（0.13 至 0.36））。潜在风险降低的平均水平在 47%至 70%之间。与 Mellibase 值相比，全科医生平均高估风险三倍。每位患者预期寿命潜在延长的平均估计接近 10 年，而 Mellibase 的计算结果在 3 至 10 年之间。
结论
高估可能导致不必要的治疗和资源浪费。
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