Kaiser Permanente, Santa Clara, California, USA.
Popul Health Manag. 2012 Aug;15(4):207-15. doi: 10.1089/pop.2011.0052. Epub 2011 Dec 22.
Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management.
在美国，糖尿病管理中存在种族和收入差距。三分之一的患有糖尿病的非裔美国人和西班牙裔美国人接受了推荐的糖尿病服务（糖化血红蛋白 [A1c] 测试、视网膜和足部检查），这些服务可降低糖尿病并发症和死亡率，而有一半的白人糖尿病患者接受了这些服务。亚裔美国人的国家数据有限，但研究表明，那些存在语言和文化障碍的人难以获得医疗服务。糖尿病登记册已被证明可以改善具有糖尿病的人群的治疗过程和临床结果。本研究探讨了加利福尼亚州圣克拉拉县的一个主要为低收入亚裔美国移民服务的社区中心是否可以通过实施糖尿病登记册来改善糖尿病护理和结果。该登记册是使用 Access 2007 软件程序构建的。通过查看图表、预约数据库以及从医疗补助、医疗保险和私人保险公司的报销记录，共确定了 580 名糖尿病患者。利用该登记册，医疗助理联系患者进行随访预约，医疗服务提供者检查并跟踪患者的 A1c 结果。在返回接受治疗的 431 名患者中，A1c 平均值在 8 个月内从 7.27%降至 6.97%（P<0.001）。尽管干预后有 10.8%的患者从控制良好转变为控制不佳的糖尿病，但 32.6%的控制不佳的糖尿病患者转变为控制良好的糖尿病（P<0.001）。研究结束时，糖尿病控制率从 47%提高到 59%。本研究表明，糖尿病登记册是管理服务不足的糖尿病患者的有效工具，从而减少了糖尿病管理中的差异。
