Badrick Ellena, Hull Sally, Mathur Rohini, Shajahan Shamin, Boomla Kambiz, Bremner Stephen, Robson John
1Research Fellow, Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK.
2Reader, Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK.
Prim Health Care Res Dev. 2014 Jan;15(1):80-95. doi: 10.1017/S1463423612000606. Epub 2013 Feb 4.
This quality improvement project was set in Tower Hamlets, east London, with the aim of reducing health inequalities by ethnicity, age and gender in the management of three common chronic diseases.
Routinely collected clinical data were extracted from practice computer systems using Morbidity Information Query and Export Syntax (MIQUEST) and Egton Medical Information Systems (EMIS) Web, between 2007 and 2010. Health equity audits for 38 practices in Tower Hamlets primary care trust (PCT) were constructed to cover key process and outcome measures for each of the three major chronic diseases: coronary heart disease (CHD), type 2 diabetes mellitus and chronic obstructive pulmonary disease (COPD). The equity audit was disseminated to practices along with facilitation sessions.
We show evidence of baseline inequalities in each condition across the three east London PCTs. The intervention tracked four key indicators (cholesterol levels in CHD, blood pressure and haemoglobin A1c levels in diabetes and % smoking in COPD). Performance for physician-driven interventions improved, but smoking rates remained static. All ethnic groups showed improvement, but there was no evidence of a reduction in differences between ethnic groups. Reductions in gender and age group differences were noted in diabetes and CHD.
Using routine clinical data, it is possible to develop practice-level health equity reports. These can unmask previously hidden inequalities between groups, and promote discussion with practice teams to stimulate strategies for improvements in performance. Steady improvements in chronic disease management were observed, however, systematic differences between ethnic groups remain. We are not able to attribute observed changes to the audits. These reports illustrate the importance of collecting ethnicity data at practice level. Tools such as this audit can be adapted to monitor inequalities in primary care settings.
本质量改进项目位于伦敦东部的陶尔哈姆莱茨区，旨在减少三种常见慢性病管理中因种族、年龄和性别导致的健康不平等现象。
2007年至2010年期间，使用发病率信息查询与导出语法（MIQUEST）和埃格顿医疗信息系统（EMIS）网络，从实践计算机系统中提取常规收集的临床数据。构建了陶尔哈姆莱茨区初级保健信托基金（PCT）38家诊所的健康公平性审计，以涵盖三种主要慢性病（冠心病、2型糖尿病和慢性阻塞性肺疾病）各自的关键过程和结果指标。公平性审计与促进会议一起分发给各诊所。
我们展示了伦敦东部三个初级保健信托基金中每种疾病的基线不平等证据。干预措施跟踪了四个关键指标（冠心病中的胆固醇水平、糖尿病中的血压和糖化血红蛋白水平以及慢性阻塞性肺疾病中的吸烟率）。医生主导干预措施的表现有所改善，但吸烟率保持不变。所有种族群体都有改善，但没有证据表明种族群体之间的差异有所减少。在糖尿病和冠心病中，性别和年龄组差异有所减少。
利用常规临床数据，可以编制诊所层面的健康公平报告。这些报告可以揭示群体之间以前隐藏的不平等现象，并促进与诊所团队的讨论，以激发提高绩效的策略。观察到慢性病管理稳步改善，然而，种族群体之间的系统性差异仍然存在。我们无法将观察到的变化归因于审计。这些报告说明了在诊所层面收集种族数据的重要性。这样的审计工具可以进行调整，以监测初级保健环境中的不平等现象。
