Charles Darwin University, NT, Australia.
Diabetes Metab Res Rev. 2010 Sep;26(6):464-73. doi: 10.1002/dmrr.1062.
Examining variation in diabetes care across regions/organizations provides insight into underlying factors related to quality of care. The aims of this study were to assess quality of diabetes care and its variation among Aboriginal community health centres in Australia, and to estimate partitioning of variation attributable to health centre and individual patient characteristics.
During 2005-2009, clinical medical audits were conducted in 62 Aboriginal community health centres from four states/territories. Main outcome measures include adherence to guidelines-scheduled processes of diabetes care, treatment and medication adjustment, and control of HbA(1c), blood pressure, total cholesterol and albumin/creatinine ratio (ACR).
Wide variation was observed across different categories of diabetes care measures and across centres: (1) overall adherence to delivery of services averaged 57% (range 22-83% across centres); (2) medication adjustment rates after elevated HbA(1c): 26% (0-72%); and (3) proportions of patients with HbA(1c) < 7%:27% (0-55%); with blood pressure < 130/80 mmHg: 36% (0-59%). Health centre level characteristics accounted for 36% of the total variation in adherence to process measures, and 3-11% of the total variation in patient intermediate outcomes; the remaining, substantial amount of variation in each measure was attributable to patient level characteristics.
Deficiencies in a range of quality of care measures provide multiple opportunities for improvement. The majority of variation in quality of diabetes care appears to be attributable to patient level characteristics. Further understanding of factors affecting variation in the care of individuals should assist clinicians, managers and policy makers to develop strategies to improve quality of diabetes care in Aboriginal communities.
检查不同地区/机构之间的糖尿病治疗差异可以深入了解与护理质量相关的潜在因素。本研究的目的是评估澳大利亚原住民社区卫生中心的糖尿病护理质量及其差异，并估计卫生中心和个体患者特征对差异的贡献。
在 2005 年至 2009 年期间，对来自四个州/地区的 62 个原住民社区卫生中心进行了临床医疗审核。主要结果指标包括：遵守指南规定的糖尿病护理程序，治疗和药物调整，以及控制糖化血红蛋白（HbA1c）、血压、总胆固醇和白蛋白/肌酐比（ACR）。
在不同类别的糖尿病护理措施和中心之间观察到广泛的差异：（1）总体服务提供的遵医率平均为 57%（中心之间的范围为 22%-83%）；（2）HbA1c 升高后的药物调整率：26%（0%-72%）；（3）HbA1c<7%的患者比例：27%（0%-55%）；血压<130/80mmHg 的患者比例：36%（0%-59%）。卫生中心特征占遵医率过程措施总变异的 36%，患者中间结果总变异的 3%-11%；每个措施中剩余的大量变异归因于患者水平特征。
一系列护理质量措施存在缺陷，为改进提供了多种机会。糖尿病护理质量的大部分差异似乎归因于患者水平特征。进一步了解影响个体护理差异的因素应有助于临床医生、管理人员和政策制定者制定策略，改善原住民社区的糖尿病护理质量。
