内科住院医师培训中的连续性诊所模式与糖尿病治疗效果：门诊协作教育创新项目的研究结果

Continuity Clinic Model and Diabetic Outcomes in Internal Medicine Residencies: Findings of the Educational Innovations Project Ambulatory Collaborative.

作者信息

Francis Maureen D, Julian Katherine A, Wininger David A, Drake Sean, Bollman KeriLyn, Nabors Christopher, Pereira Anne, Rosenblum Michael, Zelenski Amy B, Sweet David, Thomas Kris, Varney Andrew, Warm Eric, Francis Mark L

出版信息

J Grad Med Educ. 2016 Feb;8(1):27-32. doi: 10.4300/JGME-D-15-00073.1.

DOI:10.4300/JGME-D-15-00073.1

PMID:26913099

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4763392/

Abstract

BACKGROUND

Efforts to improve diabetes care in residency programs are ongoing and in the midst of continuity clinic redesign at many institutions. While there appears to be a link between resident continuity and improvement in glycemic control for diabetic patients, it is uncertain whether clinic structure affects quality measures and patient outcomes.

METHODS

This multi-institutional, cross-sectional study included 12 internal medicine programs. Three outcomes (glycemic control, blood pressure control, and achievement of target low-density lipoprotein [LDL]) and 2 process measures (A1C and LDL measurement) were reported for diabetic patients. Traditional, block, and combination clinic models were compared using analysis of covariance (ANCOVA). Analysis was adjusted for continuity, utilization, workload, and panel size.

RESULTS

No significant differences were found in glycemic control across clinic models (P = .06). The percentage of diabetic patients with LDL < 100 mg/dL was 60% in block, compared to 54.9% and 55% in traditional and combination models (P = .006). The percentage of diabetic patients with blood pressure < 130/80 mmHg was 48.4% in block, compared to 36.7% and 36.9% in other models (P < .001). The percentage of diabetic patients with HbA1C measured was 92.1% in block compared to 75.2% and 82.1% in other models (P < .001). Also, the percentage of diabetic patients with LDL measured was significantly different across all groups, with 91.2% in traditional, 70.4% in combination, and 83.3% in block model programs (P < .001).

CONCLUSIONS

While high scores on diabetic quality measures are achievable in any clinic model, the block model design was associated with better performance.

摘要

背景

在住院医师培训项目中，改善糖尿病护理的努力一直在进行，许多机构正在对连续性门诊进行重新设计。虽然住院医师的连续性与糖尿病患者血糖控制的改善之间似乎存在联系，但尚不确定门诊结构是否会影响质量指标和患者预后。

方法

这项多机构横断面研究纳入了12个内科项目。报告了糖尿病患者的三项预后指标（血糖控制、血压控制和达到目标低密度脂蛋白[LDL]）和两项过程指标（糖化血红蛋白[A1C]和LDL测量）。使用协方差分析（ANCOVA）对传统、分组和组合门诊模式进行比较。分析针对连续性、利用率、工作量和患者组规模进行了调整。

结果

各门诊模式在血糖控制方面未发现显著差异（P = 0.06）。分组模式中LDL<100mg/dL的糖尿病患者百分比为60%，而传统模式和组合模式分别为54.9%和55%（P = 0.006）。分组模式中血压<130/80mmHg的糖尿病患者百分比为48.4%，其他模式分别为36.7%和36.9%（P<0.001）。分组模式中测量糖化血红蛋白的糖尿病患者百分比为92.1%，其他模式分别为75.2%和82.1%（P<0.001）。此外，各组中测量LDL的糖尿病患者百分比也存在显著差异，传统模式为91.2%，组合模式为70.4%，分组模式为83.3%（P<0.001）。