Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO
Emory University School of Medicine, Atlanta, GA.
J Am Heart Assoc. 2017 Aug 11;6(8):e005999. doi: 10.1161/JAHA.117.005999.
Although guidelines and performance measures exist for patients with diabetes mellitus, achievement of these metrics is not well known. The Diabetes Collaborative Registry (DCR) was formed to understand the quality of diabetes mellitus care across the primary and specialty care continuum in the United States.
We assessed the frequency of achievement of 7 diabetes mellitus-related quality metrics and variability across the Diabetes Collaborative Registry sites. Among 574 972 patients with diabetes mellitus from 259 US practices, median (interquartile range) achievement of the quality metrics across the practices was the following: (1) glycemic control: 19% (5-47); (2) blood pressure control: 80% (67-88); (3) angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in patients with coronary artery disease: 62% (51-69); (4) nephropathy screening: 62% (53-71); (5) eye examination: 0.7% (0.0-79); (6) foot examination: 0.0% (0.0-2.3); and (7) tobacco screening/cessation counseling: 86% (80-94). In hierarchical, modified Poisson regression models, there was substantial variability in meeting these metrics across sites, particularly with documentation of glycemic control and eye and foot examinations. There was also notable variation across specialties, with endocrinology practices performing better on glycemic control and diabetes mellitus foot examinations and cardiology practices succeeding more in blood pressure control and use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers.
The Diabetes Collaborative Registry was established to document and improve the quality of outpatient diabetes mellitus care. While target achievement of some metrics of cardiovascular risk modification was high, achievement of others was suboptimal and highly variable. This may be attributable to fragmentation of care, lack of ownership among various specialists concerning certain domains of care, incomplete documentation, true gaps in care, or a combination of these factors.
虽然有针对糖尿病患者的指南和绩效指标，但这些指标的达标情况尚不清楚。成立糖尿病协作注册中心（DCR）是为了了解美国初级保健和专科保健连续体中糖尿病的护理质量。
我们评估了美国 259 个实践点的 574972 例糖尿病患者在 7 项糖尿病相关质量指标上的达标频率和各实践点间的差异。中位数（四分位间距）显示，在各实践点的达标情况如下：（1）血糖控制：19%（5-47）；（2）血压控制：80%（67-88）；（3）冠心病患者使用血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂：62%（51-69）；（4）肾病筛查：62%（53-71）；（5）眼部检查：0.7%（0.0-79）；（6）足部检查：0.0%（0.0-2.3）；（7）烟草筛查/戒烟咨询：86%（80-94）。在分层、修正泊松回归模型中，这些指标的达标情况在各实践点间存在较大差异，特别是血糖控制以及眼部和足部检查的记录。不同专业间也存在显著差异，内分泌科在血糖控制和糖尿病足部检查方面表现较好，而心脏病科在血压控制和使用血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂方面更成功。
糖尿病协作注册中心成立的目的是记录和提高门诊糖尿病护理质量。尽管某些心血管风险修正指标的达标率较高，但其他指标的达标率不理想且差异较大。这可能归因于护理的碎片化、各专科对某些护理领域缺乏自主权、记录不完整、护理真正存在差距，或这些因素的综合作用。
