Research assistant in the Department of Family Medicine at the University of Calgary in Alberta at the time of the study.
Clinical Assistant Professor in the Cumming School of Medicine at the University of Calgary and a family physician at the Associate Clinic in Pincher Creek, Alta.
Can Fam Physician. 2018 Aug;64(8):e346-e353.
To explore clinical indicators among patients with diabetes in southern Alberta and assess changes over time, and to compare patients with diabetes attending a reference clinic (RC), which had adapted its service model to address the specific needs of the patient population, with patients with diabetes attending comparison clinics (CCs) in the same region.
Analysis of longitudinal data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN).
Rural southern Alberta.
A community-based family medicine clinic and the 6 other CPCSSN clinics in the same region at the time of the study.
A range of data elements from patients with diabetes within the RC, as well as from patients with diabetes from the CCs, were analyzed by CPCSSN to compare rates of comorbidity and mean body mass index, hemoglobin A levels, and blood pressure, as well as service use and measurement frequency. Rate of change per year was modeled longitudinally for each of the outcomes.
The RC had higher proportions of patients with comorbid conditions and a consistently higher mean body mass index. Mean HbA levels varied minimally between the RC and CCs, with both sets worsening slightly. However, the rate of worsening among patients with diabetes in the RC was found to be significantly greater ( < .05) than for those in the CCs. Blood pressure also varied minimally between the RC and the CCs, with both sets improving; however, the RC had a significantly greater ( < .001) rate of improvement than the CCs did. Finally, a greater proportion of patients in the RC had complete data for these 3 outcome measures, and RC patients made a greater number of clinic visits compared with the CC patients ( < .001).
This study describes a team-based comanagement organizational model and might provide useful commentary about organizational effectiveness in primary care. Although improvement in health outcomes cannot be directly attributed to any specific change in clinic organization, some statistically and likely clinically significant benefit was found associated with the service model of the RC in a relatively medically and socially challenged patient population and in a conservative evaluative design.
探索艾伯塔省南部糖尿病患者的临床指标，并评估其随时间的变化情况，同时比较在同一地区参加参照诊所（RC）和比较诊所（CC）的糖尿病患者。RC 已经调整了其服务模式以满足患者群体的特定需求，而 CC 则没有。
对加拿大初级保健监测网络（CPCSSN）的纵向数据进行分析。
艾伯塔省南部农村。
RC 中的社区基础家庭医学诊所和同一时期该地区的 CPCSSN 的其他 6 个诊所的糖尿病患者。
通过 CPCSSN 分析 RC 中糖尿病患者以及 CC 中糖尿病患者的一系列数据元素，比较合并症发生率和平均体重指数、血红蛋白 A 水平和血压以及服务利用和测量频率。对每个结果进行了纵向的年度变化率建模。
RC 中合并症患者的比例更高，平均体重指数也一直较高。RC 和 CC 之间的平均 HbA 水平差异极小，且均略有恶化。然而，RC 中糖尿病患者的病情恶化速度明显快于 CC（<0.05）。血压在 RC 和 CC 之间也差异极小，且均有所改善；但 RC 的改善速度明显快于 CC（<0.001）。最后，RC 中有更多患者完整记录了这 3 项结果测量数据，且 RC 患者的就诊次数也明显多于 CC 患者（<0.001）。
本研究描述了一种基于团队的共同管理组织模式，可能对初级保健中的组织效果提供有用的评价。尽管健康结果的改善不能直接归因于诊所组织的任何特定变化，但在相对具有医疗和社会挑战的患者群体和保守的评估设计中，RC 的服务模式与统计学上和可能临床上显著的获益相关。
