患者并存及不并存的慢性病对糖尿病护理质量指标的影响。
The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures.
作者信息
Magnan Elizabeth M, Palta Mari, Johnson Heather M, Bartels Christie M, Schumacher Jessica R, Smith Maureen A
机构信息
Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
出版信息
J Diabetes Complications. 2015 Mar;29(2):288-94. doi: 10.1016/j.jdiacomp.2014.10.003. Epub 2014 Oct 13.
AIMS
Most patients with diabetes have comorbid chronic conditions that could support (concordant) or compete with (discordant) diabetes care. We sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality.
METHODS
Logistic regression analysis of electronic health record data from 7 health systems on 24,430 patients with diabetes aged 18-75 years. Diabetes testing and control quality care goals were the outcome variables. The number of diabetes-concordant and the number of diabetes-discordant conditions were the main explanatory variables. Analysis was adjusted for health care utilization, health system and patient demographics.
RESULTS
A higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. There was no to minimal positive association between the number of discordant conditions and outcomes, except for cholesterol testing which was less likely with 4+ discordant conditions.
CONCLUSIONS
Having more concordant conditions makes diabetes care goal achievement more likely. The number of discordant conditions has a smaller, inconsistently significant impact on diabetes goal achievement. Interventions to improve diabetes care need to align with a patient's comorbidities, including the absence of comorbidities, especially concordant comorbidities.
目的
大多数糖尿病患者患有共病慢性病，这些疾病可能支持（一致）或与糖尿病护理竞争（不一致）。我们试图确定一致和不一致慢性病数量对糖尿病护理质量的影响。
方法
对来自7个医疗系统的24430名18 - 75岁糖尿病患者的电子健康记录数据进行逻辑回归分析。糖尿病检测和控制质量护理目标为结果变量。糖尿病一致疾病数量和糖尿病不一致疾病数量为主要解释变量。分析针对医疗保健利用、医疗系统和患者人口统计学进行了调整。
结果
除血压控制外，较高数量的一致疾病与所有结果实现检测和控制目标的较高几率相关。不一致疾病数量与结果之间不存在或仅有极小的正相关，除了胆固醇检测，4种及以上不一致疾病时胆固醇检测可能性较小。
结论
有更多一致疾病使实现糖尿病护理目标的可能性更大。不一致疾病数量对糖尿病目标实现的影响较小且不一致显著。改善糖尿病护理的干预措施需要与患者的共病情况相匹配，包括无共病情况，尤其是一致的共病情况。
Zotero 插件