Geisinger Medical Center, Danville, Pennsylvania.
Arthritis Care Res (Hoboken). 2018 Nov;70(11):1679-1685. doi: 10.1002/acr.23544.
To pilot a primary care gout management improvement intervention.
Two large primary care sites were selected: 1 underwent the intervention, the other, a control, underwent no intervention. The intervention consisted of engagement of intervention-site staff, surveys of provider performance improvement preferences, and onsite live and enduring online education. Electronic health record reminders were constructed. Both the intervention and control sites had 3 quality measures assessed monthly: the percentage of gout patients treated with urate-lowering therapy, the percentage of treated patients monitored with serum urate, and the percentage of treated patients at target serum urate ≤6.0 mg/dl. The intervention-site providers received monthly reports comparing their measures against their peers.
By 6 months, the intervention site significantly improved all 3 gout performance measures. The percentage treated increased from 54.4% to 61.1% (odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.08-1.31]; P < 0.001), the percentage monitored increased from 56.1% to 79.2% (OR 1.52 [95% CI 1.24-1.87]; P < 0.001), and the percentage at goal increased from 26.85% to 43.3% (OR 1.43 [95% CI 1.16-1.77]; P < 0.001). At 6 months after intervention, gout patients at the intervention site were more likely to be monitored (79.2% versus 53.4% [OR 3.54 (95% CI 2.30-5.45)]; P < 0.001) and at goal (43.3% versus 28.3% [OR 1.99 (95% CI 1.33-2.96)]; P < 0.001) than control-site patients. Numbers treated did not significantly improve over the control site.
A pilot multifaceted gout management program can significantly improve primary care gout management performance.
试点初级保健痛风管理改进干预措施。
选择了两个大型初级保健场所：一个接受干预，另一个作为对照，不接受干预。干预措施包括干预场所工作人员的参与、调查提供者对绩效改进的偏好，以及现场直播和持久的在线教育。构建了电子健康记录提醒。干预和对照站点每月评估 3 项质量指标：接受降尿酸治疗的痛风患者比例、接受治疗的患者监测血清尿酸的比例以及接受治疗的患者血清尿酸目标值≤6.0mg/dl 的比例。干预站点的提供者每月收到比较其指标与同行的报告。
在 6 个月时，干预组的所有 3 项痛风表现指标均显著改善。治疗比例从 54.4%增加到 61.1%（比值比 [OR] 1.19 [95%置信区间 (95%CI) 1.08-1.31]；P < 0.001），监测比例从 56.1%增加到 79.2%（OR 1.52 [95%CI 1.24-1.87]；P < 0.001），目标比例从 26.85%增加到 43.3%（OR 1.43 [95%CI 1.16-1.77]；P < 0.001）。干预 6 个月后，干预组的痛风患者更有可能被监测（79.2%比 53.4%[OR 3.54 (95%CI 2.30-5.45)]；P < 0.001）和达标（43.3%比 28.3%[OR 1.99 (95%CI 1.33-2.96)]；P < 0.001）比对照组患者。治疗人数与对照组相比没有显著增加。
一个试点多方面的痛风管理计划可以显著改善初级保健痛风管理绩效。
