Sperl-Hillen JoAnn M, Solberg Leif I, Hroscikoski Mary C, Crain A Lauren, Engebretson Karen I, O'Connor Patrick J
HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA.
Prev Chronic Dis. 2008 Jan;5(1):A16. Epub 2007 Dec 15.
The study analyzes the effect of an advanced access program on quality of diabetes care.
We conducted this study in a medical group of 240,000 members served by 17 primary care clinics. Seven thousand adult patients older than 18 years of age with diabetes were identified from administrative databases. Two aspects of advanced access - wait time for appointments and continuity of care - were calculated yearly for each patient during 1999 through 2001. We developed three composite measures of glucose and lipid control - process (proportion of patients with appropriate testing rates of hemoglobin A1c [HbA1c] and low-density lipoprotein [LDL]), good control (proportion with HbA1c < 8% and LDL < 130 mg/dL) and excellent control (proportion with HbA1c < 7% and LDL < 100 mg/dL) - and assessed them each year for each patient. We used multilevel logistic regression to predict the measures in 2000 and 2001 (years during and after advanced access implementation) relative to 1999 (year pre-advanced access).
After implementation of advanced access, wait time decreased from 21.6 days to 4.2 days, and continuity improved by 6.5% (both P < .01). The percentage of patients with HbA1c < 7% increased from 44.4% to 52.3% and with LDL < 100 mg/dL from 29.8% to 38.7%. Increased continuity predicted improved process (P = .01), good control (P = .033), and excellent control (P < .001). However, wait time did not significantly predict process (P = .62) or quality measures (P = .95).
Measures of the quality of diabetes control improved in the year after implementation of advanced access, but better care did not correlate with decreased wait time to see a provider. However, improved continuity of care predicted improvements in both process and quality of diabetes care.
本研究分析了一项高级预约计划对糖尿病护理质量的影响。
我们在一个由17家初级保健诊所服务的拥有240,000名成员的医疗集团中开展了这项研究。从管理数据库中识别出7000名年龄超过18岁的成年糖尿病患者。在1999年至2001年期间，每年计算每位患者高级预约的两个方面——预约等待时间和护理连续性。我们制定了三项血糖和血脂控制的综合指标——过程指标（血红蛋白A1c [HbA1c]和低密度脂蛋白[LDL]检测率合适的患者比例）、良好控制指标（HbA1c < 8%且LDL < 130 mg/dL的患者比例）和优秀控制指标（HbA1c < 7%且LDL < 100 mg/dL的患者比例）——并每年对每位患者进行评估。我们使用多水平逻辑回归来预测2000年和2001年（高级预约实施期间及之后的年份）相对于1999年（高级预约实施前的年份）的指标。
实施高级预约后，等待时间从平均21.6天降至4.2天，连续性提高了6.5%（P均 <.01）。HbA1c < 7%的患者比例从44.4%增至52.3%，LDL < 100 mg/dL的患者比例从29.8%增至38.7%。护理连续性的提高预示着过程指标（P =.01）、良好控制指标（P =.033）和优秀控制指标（P <.001）的改善。然而，等待时间对过程指标（P =.62）或质量指标（P =.95）并无显著预测作用。
实施高级预约后的一年中，糖尿病控制质量指标有所改善，但更好的护理与缩短看诊等待时间并无关联。不过，护理连续性的改善预示着糖尿病护理的过程和质量均有所提升。
