Vaez Kelly, Diegel-Vacek Lauren, Ryan Catherine, Martyn-Nemeth Pamela
Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
Health Serv Res Manag Epidemiol. 2017 Oct 6;4:2333392817734206. doi: 10.1177/2333392817734206. eCollection 2017 Jan-Dec.
People with serious mental illness (SMI) have a higher incidence of type 2 diabetes mellitus (T2DM) and shorter life span due to medical health problems. The chronic care model (CCM) has been used to improve care of patients with T2DM. One clinical organization that provided primary care to patients with SMI had excellent diabetes outcomes but did not have information on how they achieved those outcomes. Thus, we conducted a pilot study chart review for 30 patients with T2DM and SMI to determine how well the clinic's system aligned with the overall CCM components and which components correlated with diabetes control. We also evaluated use of the CCM using the Assessment of Chronic Illness Care provider survey. Results showed that the clinic had an overall basic implementation level of the CCM, which allows opportunity for improvement. Two elements of the CCM were correlated with hemoglobin A and both were in an unexpected direction: self-management support in the variable of percentage of visits that included patient-specific goal-setting (s = .52; = .004) and delivery system design in the variable of number of nurse practitioner visits per study period ( = .43; = .02). These findings suggest that the clinic may have made more concentrated efforts to manage diabetes for patients who were not in good diabetes control. Providers noted the influence of SMI and social service organization support on these patients' clinical outcomes. The findings will be reexamined after a fuller implementation of the CCM to further improve management in this population.
患有严重精神疾病（SMI）的人群因医疗健康问题，患2型糖尿病（T2DM）的几率更高，寿命也更短。慢性护理模式（CCM）已被用于改善T2DM患者的护理。一家为SMI患者提供初级护理的临床机构在糖尿病治疗方面取得了出色的成果，但却没有关于他们如何取得这些成果的信息。因此，我们对30名患有T2DM和SMI的患者进行了一项试点研究图表审查，以确定该诊所的系统与CCM整体组成部分的契合程度，以及哪些组成部分与糖尿病控制相关。我们还使用慢性病护理评估提供者调查对CCM的使用情况进行了评估。结果显示，该诊所对CCM的整体基本实施水平尚可，但仍有改进空间。CCM的两个要素与糖化血红蛋白相关，且两者的关联方向均出乎意料：在包含患者特定目标设定的就诊百分比变量中的自我管理支持（s = 0.52；P = 0.004），以及在每个研究期间执业护士就诊次数变量中的服务提供系统设计（P = 0.43；P = 0.02）。这些发现表明，该诊所可能对糖尿病控制不佳的患者在糖尿病管理方面做出了更集中的努力。提供者指出了SMI和社会服务组织支持对这些患者临床结果的影响。在更全面实施CCM后，将重新审视这些发现，以进一步改善该人群的管理。
