Department of Geriatrics Evangelisches Geriatriezentrum, Charite University Medicine Berlin, Reinickendorfer Strasse 61, Berlin, Germany.
Am J Manag Care. 2011 Jun;17(6):393-403.
To determine whether disease management programs (DMPs) for type 2 diabetes mellitus (T2DM) can improve some processes of care and intermediate outcomes.
Two cross-sectional registries of patients with T2DM were used for data extraction before (previous cohort) and after (recent cohort) introduction of DMPs in Germany (N = 78,110).
In the recent cohort, 15,293 patients were treated within the DMPs and 9791 were not. Processes of care, medications, and intermediate outcomes (achievement of treatment targets for low-density lipoprotein [LDL] cholesterol, blood pressure, and glycosylated hemoglobin [A1C]) were analyzed using multi- variable, multilevel logistic regression, adjusting for patient case-mix and physician-level clustering to derive odds ratios and 95% confidence intervals (CIs).
Availability of structured diabetes education and of lipid, blood pressure, and A1C measurements increased over time. In DMP patients, availability was significantly higher for blood pressure and A1C but not for lipid measurements. Prescription of angiotensin-converting enzyme inhibitors, oral antidiabetic drugs, and insulin increased over time and was more common in DMP patients. Statin prescription increased over time but was not influenced by DMP status. Intermediate outcomes improved over time, but DMPs had no influence on intermediate outcomes except for reaching LDL cholesterol targets (odds ratio 1.12 [95% CI 1.06, 1.19] in favor of DMPs).
While there may be some unmeasured confounding, our data suggest that improvement in processes of care by DMPs, as implemented in Germany, only partially translates into improvement of intermediate outcomes.
确定 2 型糖尿病（T2DM）的疾病管理计划（DMP）是否可以改善某些护理流程和中间结果。
在德国，使用两个 2 型糖尿病患者的横断面登记处，分别在引入 DMP 之前（前队列）和之后（近期队列）提取数据（N=78110）。
在近期队列中，15293 名患者接受了 DMP 治疗，9791 名患者未接受治疗。使用多变量、多层次逻辑回归分析护理流程、药物和中间结果（低密度脂蛋白[LDL]胆固醇、血压和糖化血红蛋白[A1C]的治疗目标达标情况），调整患者病例组合和医生水平聚类，以得出优势比和 95%置信区间（CI）。
结构化糖尿病教育以及血脂、血压和 A1C 测量的可获得性随时间推移而增加。在 DMP 患者中，血压和 A1C 的可获得性显著更高，但血脂测量的可获得性并非如此。血管紧张素转换酶抑制剂、口服降糖药和胰岛素的处方随时间推移而增加，并且在 DMP 患者中更为常见。他汀类药物的处方随时间推移而增加，但不受 DMP 状态的影响。中间结果随时间推移而改善，但 DMP 除了 LDL 胆固醇目标达标外（有利于 DMP 的优势比 1.12[95%CI1.06,1.19]），对中间结果没有影响。
尽管可能存在一些未测量的混杂因素，但我们的数据表明，德国实施的 DMP 改善护理流程仅部分转化为中间结果的改善。
