Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
Am J Manag Care. 2010 Oct 1;16(10):e256-66.
To evaluate the effect of a patient panel-support tool (PST) on care delivery for diabetes mellitus (DM) and cardiovascular disease (CVD).
Retrospective longitudinal cohort study among primary care providers (PCPs), with 2005 as the preintervention, 2006 as the implementation, and 2007 as the postintervention period.
We estimated the intervention effect using electronic medical record data and hierarchical linear models. The intervention was a PST displaying "care gaps" and recommendations for glycosylated hemoglobin, low-density lipoprotein cholesterol, and blood pressure screening and control; retinopathy, nephropathy, and foot screening; aspirin, statin, and angiotensin-converting enzyme inhibitor or beta-blocker use; and influenza and pneumococcal vaccination. Participants were qualifying PCPs and health maintenance organizations; patients. Patients had DM or CVD and 12 months of membership (n = 30,273 DM; 26,414 CVD). Main measures were mean percentages of care recommendations that were met by PCPs per patient per month (the care score).
From 2005 to 2007, the mean care score (95% confidence interval) increased for both DM and CVD, from 63.5 (62.7, 64.3) to 70.6 (69.8, 71.4) and from 67.9 (67.2, 68.7) to 72.6 (71.9, 73.3), respectively. After adjustments, DM and CVD patients had improvements in the care score of 7.6 and 5.1, respectively, in 2007 compared with 2005 (P < .001).
Delivery of care recommendations for DM and CVD improved after implementation of a PST. More research is necessary to optimize results and determine whether patient outcomes improve.
评估患者小组支持工具（PST）对糖尿病（DM）和心血管疾病（CVD）护理提供的影响。
针对初级保健提供者（PCP）的回顾性纵向队列研究，2005 年为干预前，2006 年为实施期，2007 年为干预后。
我们使用电子病历数据和分层线性模型来估计干预效果。干预措施是一种 PST，显示“护理差距”以及糖化血红蛋白、低密度脂蛋白胆固醇和血压筛查和控制、视网膜病变、肾病和足部筛查、阿司匹林、他汀类药物和血管紧张素转换酶抑制剂或β受体阻滞剂的使用、流感和肺炎球菌疫苗接种的建议。参与者为合格的 PCP 和健康维护组织；患者。患者患有 DM 或 CVD，且有 12 个月的会员资格（n = 30273 DM；26414 CVD）。主要措施是每个患者每个月 PCP 满足的护理建议的平均百分比（护理评分）。
从 2005 年到 2007 年，DM 和 CVD 的平均护理评分（95%置信区间）分别从 63.5（62.7，64.3）增加到 70.6（69.8，71.4）和从 67.9（67.2，68.7）增加到 72.6（71.9，73.3）。调整后，与 2005 年相比，2007 年 DM 和 CVD 患者的护理评分分别提高了 7.6 和 5.1（P <.001）。
实施 PST 后，DM 和 CVD 的护理建议的提供得到了改善。需要进一步研究以优化结果并确定患者的结局是否得到改善。
