Navarro-Martínez A, Suárez-Beke M P, Sánchez-Nicolás J A, Lázaro-Aragues P, de Jesús Jiménez-Vázquez E, Huertas-de Mora O
Centro de Salud Infante D. Juan Manuel, Murcia, España.
Centro de Salud Infante D. Juan Manuel, Murcia, España.
Rev Calid Asist. 2014 Nov-Dec;29(6):302-10. doi: 10.1016/j.cali.2014.11.001. Epub 2014 Dec 15.
The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association.
The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed.
An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012.
This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease.
本研究旨在根据美国糖尿病协会提出的标准，评估并改善为糖尿病患者提供的医疗服务质量。
本研究分三个阶段进行，通过分析340名患者样本的计算机化临床病史数据。第一阶段（2010年）：横断面描述性研究，评估符合糖尿病筛查、控制目标及治疗标准的患者比例。随后，医疗专业人员审查结果以促进纠正措施的实施。最后（2012年），采用相同标准进行新的评估。
观察到接受胰岛素治疗的患者数量有所增加（2010年为12.7%，2012年为20.2%）（P <.01）。在分析测定方面，符合筛查标准的患者数量也有百分比增加：糖化血红蛋白（从44.4%增至68.2%）、血脂谱（47.6% - 73.8%）、肌酐（32.5% - 73.5%）以及白蛋白 - 肌酐比值（9.2% - 24.4%）（P <.001）。2012年，仅有6.4%（CI：3.2 - 9.8）的糖尿病患者达到糖化血红蛋白<7%﹑血压<130/80 mmHg以及低密度脂蛋白胆固醇<100 mg/dl的综合目标。
本研究表明，医疗服务在分析测定目标以及接受胰岛素治疗的2型糖尿病患者数量方面有所改善。糖尿病的代谢控制也维持在最佳水平，但心血管疾病危险因素的控制仍然较差。
