Simmons David, Yu Dahai, Bunn Christopher, Cohn Simon, Wenzel Helmut, Prevost Toby
Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK, and Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia.
Primary Care and Health Sciences, Keele University, Stafford, UK.
Future Hosp J. 2015 Jun;2(2):92-98. doi: 10.7861/futurehosp.2-2-92.
Integrated care has been postulated to result in improvements to diabetes outcomes, including reduced hospitalisation. The Diabetes Integrated Care Initiative (DICI) aimed to integrate primary, secondary and community diabetes care in East Cambridgeshire and Fenland (ECF). The aims of this study were to describe changes in care and hospitalisation rates over the first 3 years of the initiative, 2009-2012. The evaluation involved a mixed-methods approach, including a before-after design with controls from adjacent geographical areas and from patients without diabetes, alongside a 30-month ethnographic study including interviews with patients and health professionals. Over the three years, admission rates among patients with diabetes in the intervention area continued to grow. In fact, the increases in admissions in ECF were 7.4% (95% CI 5.2-9.2) and 45.5% (95% CI 42.5-48.5) greater than in the neighbouring areas of Huntingdonshire and Greater Cambridge, respectively. The rates of increase in diabetic foot, non-elective or other hospital admissions were not reduced. In summary, the DICI was not associated with improved diabetes care or reduced diabetes hospitalisation over the 3 years studied, despite substantial investment. While the principle of integration remains an ideal, linking different providers in ECF, especially those that are positioned between primary and secondary care, created barriers rather than bridges to better diabetes outcomes.
综合护理被认为可以改善糖尿病治疗效果，包括减少住院率。糖尿病综合护理倡议（DICI）旨在整合剑桥郡东部和芬地（ECF）的初级、二级和社区糖尿病护理。本研究的目的是描述该倡议在2009年至2012年的头3年中护理和住院率的变化。评估采用了混合方法，包括前后设计，对照组来自相邻地理区域和无糖尿病患者，同时还有一项为期30个月的人种学研究，包括对患者和卫生专业人员的访谈。在这三年中，干预地区糖尿病患者的住院率持续上升。事实上，ECF的住院率增长分别比亨廷登郡和大剑桥郡的邻近地区高出7.4%（95%CI 5.2 - 9.2）和45.5%（95%CI 42.5 - 48.5）。糖尿病足、非选择性或其他住院率的上升并未得到缓解。总之，尽管投入了大量资金，但在研究的3年中，DICI与改善糖尿病护理或降低糖尿病住院率并无关联。虽然整合原则仍然是一个理想目标，但在ECF将不同的医疗服务提供者联系起来，尤其是那些处于初级和二级护理之间的提供者，却造成了障碍，而非通向更好糖尿病治疗效果的桥梁。
