DiPiero Albert, Dorr David A, Kelso Christine, Bowen Judith L
Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR 97239-0398, USA.
J Gen Intern Med. 2008 Nov;23(11):1749-56. doi: 10.1007/s11606-008-0751-5. Epub 2008 Aug 28.
The quality of care for diabetes continues to fall short of recommended guidelines and results. Models for improving the care of chronic illnesses advocate a multidisciplinary team approach. Yet little is known about the effectiveness of such models in an academic setting with a diverse patient population and resident physicians participating in clinical care.
To implement a chronic illness management (CIM) practice within an academic setting with part-time providers, and evaluate its impact on the completion of diabetes-specific care processes and on the achievement of recommended outcomes for patients with diabetes mellitus.
Retrospective cohort study
Patients with the diagnosis of diabetes mellitus who receive their primary care in an academic general internal medicine resident-faculty practice.
Process and outcomes measures in patients exposed to the CIM practice were compared with non-exposed patients receiving usual care.
Five hundred and sixty-five patients met inclusion criteria. Patients in the CIM practice experienced a significant increase in completion of care processes compared to control patients for measurement of annual low-density lipoprotein (LDL) cholesterol (OR 3.1, 95% CI 1.7-5.7), urine microalbumin (OR 3.3, 95% CI 2.1-5.5), blood pressure (OR 1.8, 95% CI 1.1-2.8), retinal examination (OR 1.9, 95% CI 1.3-2.7), foot monofilament examination (OR 4.2, 95% CI 3.0-6.1) and administration of pneumococcal vaccination (OR 5.2, 95% CI 3.0-9.3). CIM-exposed patients were also more likely to achieve improvements in clinical outcomes of glycemic and blood pressure control reflected by hemoglobin A1c less than 7.0% (OR 1.7, 95% CI 1.02-3) and blood pressure less than 130/80 (OR 2.8, 95% CI 2.1-4.5) compared to controls.
A systematic chronic care model can be successfully integrated into an academic general internal medicine practice and may result in improved processes of care and some clinical outcomes for diabetic patients. This study provides a model for further hypothesis generation and more rigorous testing of the quality benefits of structured chronic illness care in diverse outpatient practices.
糖尿病护理质量仍未达到推荐指南和预期效果。改善慢性病护理的模式提倡采用多学科团队方法。然而，对于这种模式在患者群体多样且住院医师参与临床护理的学术环境中的有效性，人们了解甚少。
在一个有兼职医护人员的学术环境中实施慢性病管理（CIM）实践，并评估其对糖尿病特定护理流程的完成情况以及糖尿病患者推荐治疗效果的影响。
回顾性队列研究
在学术性普通内科住院医师 - 教师实践中接受初级护理的糖尿病患者。
将接受CIM实践的患者的护理流程和治疗效果指标与接受常规护理的未参与患者进行比较。
565名患者符合纳入标准。与对照组患者相比，接受CIM实践的患者在年度低密度脂蛋白（LDL）胆固醇检测（比值比[OR] 3.1，95%置信区间[CI] 1.7 - 5.7）、尿微量白蛋白检测（OR 3.3，95% CI 2.1 - 5.5）、血压检测（OR 1.8，95% CI 1.1 - 2.8）、视网膜检查（OR 1.9，95% CI 1.3 - 2.7）、足部单丝检查（OR 4.2，95% CI 3.0 - 6.1）以及肺炎球菌疫苗接种（OR 5.2，95% CI 3.0 - 9.3）等护理流程的完成率上有显著提高。与对照组相比，接受CIM实践的患者在糖化血红蛋白低于7.0%（OR 1.7，95% CI 1.
