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3
Importance of family/social support and impact on adherence to diabetic therapy.家庭/社会支持的重要性及其对糖尿病治疗依从性的影响。
Diabetes Metab Syndr Obes. 2013 Nov 6;6:421-6. doi: 10.2147/DMSO.S36368.
4
Measuring primary care organizational capacity for diabetes care coordination: the Diabetes Care Coordination Readiness Assessment.评估基层医疗组织协调糖尿病护理的能力：糖尿病护理协调准备情况评估
J Gen Intern Med. 2014 Jan;29(1):98-103. doi: 10.1007/s11606-013-2566-2. Epub 2013 Jul 30.
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Standardizing the power of the Hosmer-Lemeshow goodness of fit test in large data sets.在大数据集中标准化 Hosmer-Lemeshow 拟合优度检验的功效。
Stat Med. 2013 Jan 15;32(1):67-80. doi: 10.1002/sim.5525. Epub 2012 Jul 26.
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Social support and self-management behaviour among patients with Type 2 diabetes.2 型糖尿病患者的社会支持与自我管理行为。
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8
The relationship between organizational climate and quality of chronic disease management.组织氛围与慢性病管理质量之间的关系。
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The challenge of multiple comorbidity for the US health care system.美国医疗保健系统面临的多重合并症挑战。
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Importance of health system context for evaluating utilization patterns across systems.评估跨系统利用模式时卫生系统背景的重要性。
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纵向分析初级保健中糖尿病护理质量和关系氛围。

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care.

机构信息

Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.

Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.

出版信息

Health Serv Res. 2018 Apr;53(2):1042-1064. doi: 10.1111/1475-6773.12675. Epub 2017 Mar 10.

DOI:10.1111/1475-6773.12675
PMID:28294310
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5867181/
Abstract

OBJECTIVE

To assess the influence of relational climate on quality of diabetes care.

DATA SOURCES/STUDY SETTING: The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets.

STUDY DESIGN

Multilevel panel data (2008-2012) with patients nested into clinics.

DATA COLLECTION/EXTRACTION METHODS: Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure).

PRINCIPAL FINDINGS

The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes.

CONCLUSIONS

Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care.

摘要

目的

评估关系氛围对糖尿病护理质量的影响。

资料来源/研究场所：本研究在退伍军人事务部（VA）进行。VA 全体员工调查（AES）用于测量关系氛围。患者和医疗机构特征从 VA 行政数据集收集。

研究设计

具有患者嵌套在诊所中的 2008-2012 年多水平面板数据。

资料收集/提取方法：使用 ICD-9 代码识别糖尿病患者，并将其分配到初级保健就诊次数最高的诊所。使用了多个质量指标，包括捕捉指南遵守情况的全有或全无的过程指标、实际测试和程序数量以及三个中间连续结果（胆固醇、糖化血红蛋白和血压）。

主要发现

本研究样本包括 2010 年的 327805 名患者、212 个初级保健诊所和 101 个家长医疗机构。在所有研究年份中，有 1568180 个观察结果。关系氛围最高的诊所比关系氛围最低的诊所更有可能提供符合指南的护理，高出 25%（OR 对于 1 个单位的增加：1.02，p 值<.001）。在依赖胰岛素的糖尿病退伍军人中，这种影响是两倍。与预期相反，关系氛围对中间结果没有影响。

结论

关系氛围与测试和程序的提供呈正相关，但与糖尿病护理的中间结果无关。