Quinn Charlene C, Gruber-Baldini Ann L, Port Cynthia L, May Conrad, Stuart Bruce, Hebel J Richard, Zimmerman Sheryl, Burton Lynda, Zuckerman Ilene H, Fahlman Cheryl, Magaziner Jay
Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
J Am Geriatr Soc. 2009 Sep;57(9):1628-33. doi: 10.1111/j.1532-5415.2009.02382.x. Epub 2009 Aug 4.
To study the role of nursing home (NH) admission and dementia status on the provision of five procedures related to diabetes mellitus.
Retrospective cohort study using data from a large prospective study in which an expert panel determined the prevalence of dementia.
Fifty-nine Maryland NHs.
Three hundred ninety-nine new admission NH patients with diabetes mellitus.
Medicare administrative claims records matched to the NH medical record data were used to measure procedures related to diabetes mellitus received in the year before NH admission and up to a year after admission (and before discharge). Procedures included glycosylated hemoglobin, fasting blood glucose, dilated eye examination, lipid profile, and serum creatinine.
For all but dilated eye examinations, higher rates of procedures related to diabetes mellitus were seen in the year after NH admission than in the year before. Residents without dementia received more procedures than those with dementia, although this was somewhat attenuated after controlling for demographic, health, and healthcare utilization variables. Persons without dementia experience greater increases in procedure rates after admission than those with dementia.
The structured environment of care provided by the NH may positively affect monitoring procedures provided to elderly persons with diabetes mellitus, especially those without dementia. Medical decisions related to the risks and benefits of intensive treatment for diabetes mellitus to patients of varying frailty and expected longevity may lead to lower rates of procedures for residents with dementia.
研究养老院入住情况和痴呆状态对五项糖尿病相关诊疗程序实施的影响。
回顾性队列研究，使用来自一项大型前瞻性研究的数据，该研究中有一个专家小组确定了痴呆的患病率。
马里兰州的59家养老院。
399名新入住养老院的糖尿病患者。
将医疗保险行政索赔记录与养老院病历数据相匹配，以测量在入住养老院前一年以及入住后长达一年（及出院前）接受的糖尿病相关诊疗程序。诊疗程序包括糖化血红蛋白、空腹血糖、散瞳眼科检查、血脂谱和血清肌酐。
除散瞳眼科检查外，入住养老院后一年的糖尿病相关诊疗程序发生率均高于前一年。无痴呆的居民比有痴呆的居民接受的诊疗程序更多，不过在控制了人口统计学、健康状况和医疗服务利用变量后，这种差异有所减弱。无痴呆的人入住后诊疗程序发生率的增幅大于有痴呆的人。
养老院提供的结构化护理环境可能对糖尿病老年患者，尤其是无痴呆患者的监测诊疗程序产生积极影响。针对不同虚弱程度和预期寿命的患者进行糖尿病强化治疗的风险和益处所做出的医疗决策，可能导致痴呆患者的诊疗程序发生率较低。
