Division of Cardiology, Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California, San Francisco; Division of Research, Kaiser Permanente Northern California, Oakland.
Division of Research, Kaiser Permanente Northern California, Oakland; Department of General Internal Medicine, University of California, San Francisco.
Am J Med. 2018 Jun;131(6):661-668. doi: 10.1016/j.amjmed.2018.01.024. Epub 2018 Mar 22.
Optimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes Everyday, at Kaiser Permanente Northern California (KPNC), during 2004-2013.
We used National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set cut points to identify prevalence of poor glycemic (hemoglobin A1c > 9%) control, good lipid control (low-density lipoprotein cholesterol < 100 mg/dL), and good blood pressure control (blood pressure < 140/90 mm Hg) in each year (N range = 98,345 to 122,177 over the entire period). We assessed trends in risk factor control based on Joinpoint regression and average annual percentage change (AAPC) compared with published National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set commercial rates.
We found that the prevalence of poor glycemic control (hemoglobin A1c > 9%) declined in both KPNC and nationally, but was statistically significant only in KPNC (AAPC = -4.8; P < .05). The prevalence of good lipid control (low-density lipoprotein cholesterol < 100 mg/dL) increased significantly in KPNC (47% to 71%; AAPC = +4.3; P < .05), but there was no significant improvement nationally (40% to 44%; AAPC = +1.4; P = .2). The prevalence of blood pressure control (<140/90 mm Hg) was higher in KPNC (77% to 82%; AAPC = +1.1; P < .05) versus nationally (57% to 62%; AAPC = +1.9; P < .05) during the reported years 2007-2013.
Relative to national benchmarks, a substantially greater improvement in risk factor control among adults with diabetes was observed after implementation of a comprehensive population management program.
在糖尿病患者中，实现最佳心血管危险因素控制仍然是一个挑战。我们评估了在 2004 年至 2013 年期间，凯撒永久北加州（KPNC）实施大规模人群管理项目“预防心脏病和中风的每一天”后，糖尿病患者的血糖、血脂和血压控制情况的变化。
我们使用全国质量保证医疗效果数据和信息集（National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set，NQMC）切点来确定每年不良血糖（糖化血红蛋白>9%）控制、良好血脂控制（低密度脂蛋白胆固醇<100mg/dL）和良好血压控制（血压<140/90mmHg）的患病率（整个期间的 N 范围为 98345 至 122177）。我们根据 Joinpoint 回归评估了危险因素控制趋势，并与发表的 NQMC 商业率进行了平均年度百分比变化（average annual percentage change，AAPC）比较。
我们发现，KPNC 和全国范围内不良血糖控制（糖化血红蛋白>9%）的患病率均有所下降，但仅在 KPNC 有统计学意义（AAPC=-4.8；P<.05）。KPNC 良好血脂控制（低密度脂蛋白胆固醇<100mg/dL）的患病率显著增加（47%至 71%；AAPC=+4.3；P<.05），但全国范围内没有显著改善（40%至 44%；AAPC=+1.4；P=.2）。在报告的 2007 年至 2013 年期间，KPNC 的血压控制率（<140/90mmHg）高于全国水平（77%至 82%；AAPC=+1.1；P<.05）。
与全国基准相比，在实施全面人群管理项目后，糖尿病患者的危险因素控制得到了显著改善。
