Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Can J Diabetes. 2015 Apr;39(2):133-7. doi: 10.1016/j.jcjd.2014.10.001. Epub 2014 Dec 10.
Existing research is inconsistent on whether clinical experience is associated with improved management of type 2 diabetes mellitus. We sought to determine whether meeting diabetes quality indicators improves as general internal medicine physicians progress from first to last year of residency.
We performed a chart abstraction of electronic health records data covering the period from September 2008 to August 2011. In all, 352 patient records were abstracted and linked to year of resident provider. Type 2 diabetes quality indicators included glycated hemoglobin (A1C), low-density lipoprotein, diastolic and systolic blood pressure control, obtaining urine microalbumin or prescription for angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and documented foot and eye examinations. Chi-square tests and logistic regression analysis were used to determine whether year of residency was associated with quality of care indices before and after adjusting for patient age, gender, race, body mass index and cigarette smoking.
Urine microalbumin was the most often met indicator (76.9%), and the least often met indicator was documented eye examination (37.4%). Results of adjusted analysis indicated that the odds of A1C, low-density lipoprotein control, obtaining urine microalbumin and documented eye and foot examinations were greater among patients of second- and third-year residents compared with those of first-year residents (odds ratios range, 1.26-5.12). Urine microalbumin was the indicator most often in optimal control and least often met indicators were eye and foot examinations.
We observed improvement in quality of diabetes care throughout residency. However, the low prevalence of several quality indicators indicates a need for additional training and quality improvement.
现有研究对于临床经验是否与 2 型糖尿病的管理改善相关存在不一致的结论。我们旨在确定一般内科医生从住院医师的第一年到最后一年，其是否能够达到更多的糖尿病质量指标。
我们对电子健康记录数据进行了图表提取，涵盖了 2008 年 9 月至 2011 年 8 月期间的数据。共提取了 352 份患者记录，并将其与住院医生的年份相关联。2 型糖尿病质量指标包括糖化血红蛋白（A1C）、低密度脂蛋白、舒张压和收缩压控制、获得尿微量白蛋白或血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的处方以及记录的足部和眼部检查。我们使用卡方检验和逻辑回归分析来确定在调整患者年龄、性别、种族、体重指数和吸烟状况后，住院年限是否与医疗质量指数相关。
尿微量白蛋白是最常符合的指标（76.9%），而最不符合的指标是记录的眼部检查（37.4%）。调整分析的结果表明，与第一年住院医生的患者相比，第二年和第三年住院医生的患者更有可能达到 A1C、低密度脂蛋白控制、获得尿微量白蛋白和记录的眼部和足部检查（比值比范围为 1.26-5.12）。尿微量白蛋白是最常处于最佳控制的指标，而最不符合的指标是眼部和足部检查。
我们观察到住院医生年限内糖尿病治疗质量的提高。然而，几个质量指标的低患病率表明需要进一步的培训和质量改进。
