Rossi Maria Chiara, Candido Riccardo, Ceriello Antonio, Cimino Antonino, Di Bartolo Paolo, Giorda Carlo, Esposito Katherine, Lucisano Giuseppe, Maggini Marina, Mannucci Edoardo, Meloncelli Illidio, Nicolucci Antonio, Pellegrini Fabio, Scardapane Marco, Vespasiani Giacomo
AMD - Associazione Medici Diabetologi, Rome, Italy,
Acta Diabetol. 2015 Jun;52(3):557-71. doi: 10.1007/s00592-014-0688-6. Epub 2014 Dec 21.
Quality of care monitoring is a key strategy for health policy. In Italy, the AMD Annals continuous monitoring and quality improvement initiative has been in place since 2006. Results after 8 years are now available.
Quality of diabetes care indicators during the years 2004-2011 were extracted from electronic medical records of 300 diabetes clinics. From 200,000 to 500,000 patients with type 2 diabetes were analyzed per year. Six process indicators, eight intermediate outcome indicators, seven indicators of treatment intensity/appropriateness, and a quality of care summary score (Q score) were evaluated. Previous studies documented that the risk of developing a new cardiovascular event was 80 % higher in patients with a Q score <15 and 20 % higher in those with a score between 15 and 25, as compared to those with a score >25.
The proportion of patients with HbA1c ≤7 %, LDL cholesterol <100 mg/dl, and blood pressure ≥140/90 mmHg increased by 4.8, 21.9, and 10.0 %, respectively. Process and treatment intensity/appropriateness indicators consistently improved. The proportion of patients with a Q score <15 decreased from 13.5 to 6.5 %, while those with a Q score >25 increased from 22.9 to 38.5 %.
AMD Annals document the progress in quality of diabetes care. Longitudinal improvements in Q score can translate into less cardiovascular events, with evident clinical and economic implications. AMD Annals represent a physician-led effort not requiring allocation of extra-economic resources, which is easy to implement and deeply rooted in routine clinical practice. They are a potential case model for other healthcare systems.
医疗质量监测是卫生政策的一项关键策略。在意大利，自2006年起实施了年龄相关性黄斑变性（AMD）年鉴持续监测与质量改进计划。现在已有8年的结果。
从300家糖尿病诊所的电子病历中提取2004年至2011年期间糖尿病护理指标的质量数据。每年分析20万至50万例2型糖尿病患者。评估了六项过程指标、八项中间结果指标、七项治疗强度/适宜性指标以及一项护理质量汇总评分（Q评分）。先前的研究表明，与Q评分>25的患者相比，Q评分<15的患者发生新的心血管事件的风险高80%，评分在15至25之间的患者风险高20%。
糖化血红蛋白（HbA1c）≤7%、低密度脂蛋白胆固醇<100mg/dl以及血压≥140/90mmHg的患者比例分别增加了4.8%、21.9%和10.0%。过程指标和治疗强度/适宜性指标持续改善。Q评分<15的患者比例从13.5%降至6.5%，而Q评分>25的患者比例从22.9%增至38.5%。
AMD年鉴记录了糖尿病护理质量的进展。Q评分的纵向改善可转化为心血管事件减少，具有明显的临床和经济意义。AMD年鉴是一项由医生主导的工作，无需额外的经济资源分配，易于实施且深深扎根于日常临床实践。它们是其他医疗保健系统的潜在案例模型。
