Lee Rachel, Onopa Janet, Mau Marjorie K, Seto Todd B
Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
Hawaii Med J. 2010 May;69(5 Suppl 2):28-30.
Racial differences in diabetes care and outcomes, particularly among African Americans and Hispanics, have been well-recognized. The goal of this study was to evaluate the quality of diabetes care, using nationally recognized standards of care, in a multispecialty, hospital-based clinic that cares for a predominantly Native Hawaiian and Pacific Islander population.
We identified patients with a new primary or secondary diagnosis of diabetes during a visit (baseline visit) between January 2005 and June 2006 at the Queen Emma Clinics. Each patient's medical record was reviewed to obtain demographic and clinical information related to diabetes, including laboratory and test results and medications, from the baseline visit through 12 months follow-up. Performance indicators were selected from those recommended by the National Diabetes Quality Improvement Alliance and included selected 8 measures: 1) Hemoglobin A1c ≥9.0%; 2) Annual lipid panel checked; 3) Systolic blood pressure <140 mmHg; 4) LDL cholesterol <130 mg/dL) 5) Annual fundoscopic examination; 6) Foot examination; 7) Aspirin use; 8) Annual evaluation for urine protein.
We identified 364 patients, the majority Pacific Islanders (58%), with Asians (15%) and Native Hawaiians (17%) more frequent than Caucasians (10%). Compared with Caucasians, Native Hawaiians and Pacific Islanders were significantly more likely to have poor glucose control. There were no significant differences between groups for the other measures. Patients compared favorably when compared with national benchmarks. For 2 indicators, adherence was significantly higher for the total study population compared with the US average (systolic blood pressure <140 mmHg, aspirin therapy). For 2 indicators, there were no significant difference (LDL cholesterol <130 mg/dL, annual foot exam) and for 2 indicators, adherence was significantly lower for the study population (hemoglobin A1c >9%, annual fundoscopic examination).
Native Hawaiians and Pacific Islanders with diabetes have poorer blood glucose control compared with Caucasians and Asians, but the overall care is otherwise generally similar. The diabetes care received by patients in this clinic that treats a generally underserved population compares favorably with national benchmarks.
糖尿病护理及治疗结果方面的种族差异已得到广泛认可，尤其是在非裔美国人和西班牙裔人群中。本研究的目的是，在一家多专科、以医院为基础且主要服务于夏威夷原住民和太平洋岛民的诊所中，依据全国公认的护理标准评估糖尿病护理质量。
我们确定了2005年1月至2006年6月期间在艾玛女王诊所就诊（基线就诊）时首次被诊断为原发性或继发性糖尿病的患者。查阅每位患者的病历，以获取从基线就诊到随访12个月期间与糖尿病相关的人口统计学和临床信息，包括实验室检查结果、测试结果及用药情况。绩效指标从美国国家糖尿病质量改进联盟推荐的指标中选取，包括8项特定指标：1）糖化血红蛋白≥9.0%；2）每年进行血脂检查；3）收缩压<140 mmHg；4）低密度脂蛋白胆固醇<130 mg/dL；5）每年进行眼底检查；6）足部检查；7）使用阿司匹林；8）每年进行尿蛋白评估。
我们共确定了364名患者，其中大多数是太平洋岛民（58%），亚洲人（15%）和夏威夷原住民（17%）比白种人（10%）更常见。与白种人相比，夏威夷原住民和太平洋岛民血糖控制不佳的可能性显著更高。在其他指标方面，各群体之间没有显著差异。与全国基准相比，患者情况良好。在2项指标上，整个研究人群的依从性显著高于美国平均水平（收缩压<140 mmHg，阿司匹林治疗）。在2项指标上，没有显著差异（低密度脂蛋白胆固醇<130 mg/dL，每年足部检查），在2项指标上，研究人群的依从性显著较低（糖化血红蛋白>9%，每年眼底检查）。
与白种人和亚洲人相比，患有糖尿病的夏威夷原住民和太平洋岛民血糖控制较差，但总体护理情况大致相似。该诊所治疗的通常是服务不足人群，其患者接受的糖尿病护理与全国基准相比情况良好。
