2007 年至 2015 年日本糖尿病护理质量的变化：一项使用索赔数据的重复横断面研究。
Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data.
机构信息
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan.
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan.
出版信息
Diabetes Res Clin Pract. 2019 Mar;149:188-199. doi: 10.1016/j.diabres.2019.02.001. Epub 2019 Feb 8.
AIM
To assess the temporal changes in the quality indicators pertaining to the process measures of diabetes care during a recent decade in Japan.
METHODS
A five-fold repeated cross-sectional study was conducted using health insurance claims data provided by the Japan Medical Data Center between April 2006 and March 2016. We identified 46,631 outpatients with antidiabetic medication who regularly visited hospitals or clinics at least every three months. We evaluated the quality indicators pertaining to glycemic control monitoring, lipid profile monitoring, retinopathy screening, nephropathy screening, and appropriate medication choice. The proportions of patients who received appropriate examinations/prescriptions, by observation period and either the type of antidiabetic medication or facility type were estimated using generalized estimating equation (GEE) models with multiple covariate adjustments.
RESULTS
The quality indicator values for appropriate medication choice and nephropathy screening improved between 2007 and 2015, whereas those for glycemic control monitoring and retinopathy screening remained suboptimal. Patients prescribed medications in larger hospitals were likelier to undergo the recommended examinations (e.g. retinopathy screening: 36.1% (95% CI: 35.4-36.7%) for clinic, 40.6% (95% CI: 39.1-42.2%) for smaller hospital, and 46.0% (95% CI: 44.8-47.2%) for larger hospital in 2015).
CONCLUSIONS
Several process measures of diabetes care remained suboptimal in Japan.
目的
评估日本最近十年间糖尿病治疗过程指标的质量变化情况。
方法
采用日本医疗数据中心 2006 年 4 月至 2016 年 3 月期间提供的健康保险索赔数据，进行了五次重复横断面研究。我们确定了 46631 名定期到医院或诊所就诊（至少每三个月一次）的服用抗糖尿病药物的门诊患者。我们评估了与血糖控制监测、血脂谱监测、视网膜病变筛查、肾病筛查和适当药物选择相关的质量指标。使用具有多变量调整的广义估计方程（GEE）模型，根据观察期和抗糖尿病药物类型或医疗机构类型，估计接受适当检查/处方的患者比例。
结果
2007 年至 2015 年期间，适当药物选择和肾病筛查的质量指标值有所改善，而血糖控制监测和视网膜病变筛查的指标值仍不理想。在较大的医院开处方的患者更有可能接受推荐的检查（例如，视网膜病变筛查：2015 年诊所为 36.1%（95%CI：35.4-36.7%），较小的医院为 40.6%（95%CI：39.1-42.2%），较大的医院为 46.0%（95%CI：44.8-47.2%））。
结论
日本的一些糖尿病治疗过程指标仍不理想。
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