Profili Francesco, Bellini Irene, Zuppiroli Alfredo, Seghieri Giuseppe, Barbone Fabio, Francesconi Paolo
Regional Health Agency of Tuscany, Florence, Italy.
Medical Specialisation School of Hygiene and Preventive Medicine, Florence, Italy.
Eur J Public Health. 2017 Feb 1;27(1):14-19. doi: 10.1093/eurpub/ckw181.
In 2010, Tuscany (Italy) implemented a Chronic Care Model (CCM)-based programme for the management of chronic diseases. The study’s objective was to evaluate its impact on the care of patients with type 2 diabetes.
A population-based cohort study was performed on patients with diabetes, identified by an administrative data algorithm, exposed to a CCM-based programme versus patients not exposed (8486 patients in each group). The groups were matched using a propensity score approach and observed from 2011 to 2014. The outcomes measured were: mortality rate and hazard ratio (HR), hospitalisation incidence rate (IR) (all causes and diabetes-related diseases) and incidence rate ratio (IRR), and Guideline Composite Indicator (GCI) as proxy of adherence to guidelines (IR and IRR). Stratified Cox regression analysis and conditional fixed effect Poisson regression analyses were performed to compute HR and IRR.
A significant improvement was observed for GCI (IRR 1.58; 95% CI 1.53–1.62) and for cardiovascular long-term complications (IRR 1.11; 95% CI 1.04–1.18). A protective effect was observed for neurological long-term complications (IRR 0.85; 95% CI 0.76–0.95), acute cardio-cerebrovascular long-term complications—stroke and ST segment elevation myocardial infarction—(IRR 0.81; 95% CI 0.71–0.92) and mortality (HR 0.88; 95% CI 0.81–0.96).
The implementation of a CCM-based programme was followed by better management and benefits for the health status of patients. The increase in hospitalisations for cardiovascular long-term complications could engender cost-efficacy issues, but a better integrated care (GPs and specialists) and a more appropriate specialist outpatient services organisation could avoid a part of these, while still maintaining the benefits seen.
2010年，意大利托斯卡纳大区实施了一项基于慢性护理模式（CCM）的慢性病管理项目。该研究的目的是评估其对2型糖尿病患者护理的影响。
对通过行政数据算法识别出的糖尿病患者进行基于人群的队列研究，将暴露于基于CCM项目的患者与未暴露患者（每组8486例）进行比较。采用倾向评分法对两组进行匹配，并于2011年至2014年进行观察。测量的结局指标包括：死亡率和风险比（HR）、住院发生率（IR）（所有原因及糖尿病相关疾病）和发生率比（IRR），以及作为指南依从性代理指标的指南综合指标（GCI）（IR和IRR）。进行分层Cox回归分析和条件固定效应泊松回归分析以计算HR和IRR。
观察到GCI（IRR 1.58；95%CI 1.53 - 1.62）以及心血管长期并发症（IRR 1.11；95%CI 1.04 - 1.18）有显著改善。观察到对神经长期并发症（IRR 0.85；95%CI 0.76 - 0.95）、急性心脑血管长期并发症（中风和ST段抬高型心肌梗死）（IRR 0.81；95%CI 0.71 - 0.92）和死亡率（HR 0.88；95%CI 0.81 - 0.96）有保护作用。
实施基于CCM的项目后，患者的健康状况得到了更好的管理并从中受益。心血管长期并发症住院人数的增加可能会引发成本效益问题，但更好的综合护理（全科医生和专科医生）以及更合适的专科门诊服务组织可以避免部分此类问题，同时仍能保持已观察到的益处。
