O'Reilly D J, Bowen J M, Sebaldt R J, Petrie A, Hopkins R B, Assasi N, MacDougald C, Nunes E, Goeree R
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada ; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada ; Fig.P Software Incorporated, Hamilton, Ontario, Canada.
Ont Health Technol Assess Ser. 2014 Apr 1;14(3):1-37. eCollection 2014.
Computerized chronic disease management systems (CDMSs), when aligned with clinical practice guidelines, have the potential to effectively impact diabetes care.
The objective was to measure the difference between optimal diabetes care and actual diabetes care before and after the introduction of a computerized CDMS.
This 1-year, prospective, observational, pre/post study evaluated the use of a CDMS with a diabetes patient registry and tracker in family practices using patient enrolment models. Aggregate practice-level data from all rostered diabetes patients were analyzed. The primary outcome measure was the change in proportion of patients with up-to-date "ABC" monitoring frequency (i.e., hemoglobin A1c, blood pressure, and cholesterol). Changes in the frequency of other practice care and treatment elements (e.g., retinopathy screening) were also determined. Usability and satisfaction with the CDMS were measured.
Nine sites, 38 health care providers, and 2,320 diabetes patients were included. The proportion of patients with up-to-date ABC (12%), hemoglobin A1c (45%), and cholesterol (38%) monitoring did not change over the duration of the study. The proportion of patients with up-to-date blood pressure monitoring improved, from 16% to 20%. Data on foot examinations, retinopathy screening, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and documentation of self-management goals were not available or not up to date at baseline for 98% of patients. By the end of the study, attitudes of health care providers were more negative on the Training, Usefulness, Daily Practice, and Support from the Service Provider domains of the CDMS, but more positive on the Learning, Using, Practice Planning, CDMS, and Satisfaction domains.
Few practitioners used the CDMS, so it was difficult to draw conclusions about its efficacy. Simply giving health care providers a potentially useful technology will not ensure its use.
This real-world evaluation of a web-based CDMS for diabetes failed to impact physician practice due to limited use of the system.
Patients and health care providers need timely access to information to ensure proper diabetes care. This study looked at whether a computer-based system at the doctor's office could improve diabetes management. However, few clinics and health care providers used the system, so no improvement in diabetes care was seen.
计算机化慢性病管理系统（CDMS）若与临床实践指南相结合，有可能对糖尿病护理产生有效影响。
目的是衡量引入计算机化CDMS前后最佳糖尿病护理与实际糖尿病护理之间的差异。
这项为期1年的前瞻性观察性前后研究，使用患者登记模型评估了家庭医疗中CDMS与糖尿病患者登记和跟踪器的使用情况。对所有登记在册的糖尿病患者的综合实践层面数据进行了分析。主要结局指标是具有最新“ABC”监测频率（即糖化血红蛋白、血压和胆固醇）的患者比例的变化。还确定了其他实践护理和治疗要素（如视网膜病变筛查）频率的变化。对CDMS的可用性和满意度进行了测量。
纳入了9个地点、38名医疗保健提供者和2320名糖尿病患者。在研究期间，具有最新ABC（12%）、糖化血红蛋白（45%）和胆固醇（38%）监测的患者比例没有变化。具有最新血压监测的患者比例从16%提高到了20%。98%的患者在基线时足部检查、视网膜病变筛查、血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的使用以及自我管理目标记录的数据不可用或不最新。到研究结束时，医疗保健提供者对CDMS的培训、有用性、日常实践和服务提供者支持等领域的态度更为消极，但对学习、使用、实践规划、CDMS和满意度等领域的态度更为积极。
很少有从业者使用CDMS，因此很难就其疗效得出结论。仅仅给医疗保健提供者一项潜在有用的技术并不能确保其得到使用。
这项针对糖尿病的基于网络的CDMS的实际评估由于系统使用有限而未能影响医生的实践。
患者和医疗保健提供者需要及时获取信息以确保适当的糖尿病护理。本研究探讨了医生办公室的基于计算机的系统是否能改善糖尿病管理。然而，很少有诊所和医疗保健提供者使用该系统，因此未观察到糖尿病护理的改善。
