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[改善马卡雷纳高级糖尿病中心2型糖尿病护理流程质量指标策略的疗效]

[Efficacy of the strategy to improve the quality indicators of Diabetes Mellitus 2 Care Process in Advanced Diabetes Centre Macarena].

作者信息

Vélez Juan Manuel, García Rosa, Pina Enrique, Morales Cristóbal, Escalera Carmen, Ortega Antonio, Poyatos Blas, Carrasco Dolores, Prieto Jesús, Ángeles Eslava M, Antonio Corrales J, Barón María O, Llano Mercedes, Ruiz Francisco, Sánchez Romualdo, Victorino Pino Manuel, Luisa Redondo M, Castellanos Antonio, Mayoral Eduardo

机构信息

Centro de Salud Cazalla de la Sierra, Distrito Sanitario Sevilla Norte-Aljarafe, Sevilla, España.

Centro de Salud El Alamillo, Distrito Sanitario Sevilla, Sevilla, España.

出版信息

Aten Primaria. 2019 Jan;51(1):18-23. doi: 10.1016/j.aprim.2017.09.010. Epub 2018 Feb 22.

Abstract

INTRODUCTION

The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness' care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care.

OBJECTIVE

Analysing the quality of healthcare provided to DM2 patients.

DESIGN

Quasiexperimental study before and after intervention with a not randomised control group.

LOCATION

Health care district of primary care Sevilla.

PARTICIPANTS

12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way.

INTERVENTION

Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital.

MAIN MEASUREMENTS

Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF).

RESULTS

1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c<7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p=0.01) and retinography requested (p=0.01).

CONCLUSIONS

IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect.

摘要

引言

通过慢性病护理模式评估工具(IEMAC - 糖尿病)对2型糖尿病护理过程(PAI - DM2)进行评估,有助于设计改善医疗护理的健康干预措施。

目的

分析为2型糖尿病患者提供的医疗保健质量。

设计

采用非随机对照组的干预前后准实验研究。

地点

塞维利亚初级保健医疗区。

参与者

12组归属患者,5个初级保健健康中心,以任意方式选取。

干预措施

12个干预组的医生和护士参加了一个培训项目,包括在糖尿病日间医院的外部轮转。

主要测量指标

纳入患者数量、糖化血红蛋白、足部检查(FE)和眼底(OF)。

结果

对1475例2型糖尿病患者进行了分析。每组纳入患者的比例为8.5%,女性占45.5%。在研究开始时,2013年糖化血红蛋白<7%的患者比例为38.9%,2014年为47.7%,2016年为40.2%;2013年33%的患者进行了眼底检查,2014年为41.77%;2013年51.6%的患者进行了足部检查,2014年为54.7%。干预后,糖化血红蛋白(p = 0.01)和眼底造影检查申请(p = 0.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bca4/6837041/5c9398d094c8/fx1.jpg

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