Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Centre of Excellence, Centre for Cardiometabolic Risk Reduction in South Asia, Public Health Foundation of India, Gurgaon, India.
Diabet Med. 2020 Nov;37(11):1825-1831. doi: 10.1111/dme.14124. Epub 2019 Sep 28.
To evaluate whether and what combinations of diabetes quality metrics were achieved in a multicentre trial in South Asia evaluating a multicomponent quality improvement intervention that included non-physician care coordinators to promote adherence and clinical decision-support software to enhance physician practices, in comparision with usual care.
Using data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) trial, we evaluated the proportions of trial participants achieving specific and combinations of five diabetes care targets (HbA <53 mmol/mol [7%], blood pressure <130/80 mmHg, LDL cholesterol <2.6 mmol/L, non-smoking status, and aspirin use). Additionally, we examined the proportions of participants achieving the following risk factor improvements from baseline: ≥11-mmol/mol (1%) reduction in HbA , ≥10-mmHg reduction in systolic blood pressure, and/or ≥0.26-mmol/l reduction in LDL cholesterol.
Baseline characteristics were similar in the intervention and usual care arms. Overall, 12.3%, 29.4%, 36.5%, 19.5% and 2.2% of participants in the intervention group and 16.2%, 38.3%, 31.6%, 11.3% and 0.8% of participants in the usual care group achieved any one, two, three, four or five targets, respectively. We noted sizeable improvements in HbA , blood pressure and cholesterol, and found that participants in the intervention group were twice as likely to achieve improvements in all three indices at 12 months that were sustained over 28 months of the study [relative risk 2.1 (95% CI 1.5,2.8) and 1.8 (95% CI 1.5,2.3), respectively].
The intervention was associated with significantly higher achievement of and greater improvements in composite diabetes quality care goals. However, among these higher-risk participants, very small proportions achieved the complete group of targets, which suggests that achievement of multiple quality-of-care goals is challenging and that other methods may be needed in closing care gaps.
评估在南亚进行的一项多中心试验中，糖尿病质量指标的实现情况，该试验评估了一种多组分质量改进干预措施，包括非医师护理协调员以促进依从性和临床决策支持软件，以提高医生的实践，与常规护理相比。
使用来自南亚心血管代谢风险降低中心（CARRS）试验的数据，我们评估了试验参与者达到五个糖尿病护理目标（HbA <53 mmol/mol [7%]、血压 <130/80 mmHg、LDL 胆固醇 <2.6 mmol/L、不吸烟状态和使用阿司匹林）的具体和组合的比例。此外，我们检查了参与者从基线开始实现以下危险因素改善的比例：HbA 降低≥11 mmol/mol（1%）、收缩压降低≥10 mmHg 和/或 LDL 胆固醇降低≥0.26 mmol/L。
干预组和常规护理组的基线特征相似。总体而言，干预组 12.3%、29.4%、36.5%、19.5%和 2.2%的参与者和常规护理组 16.2%、38.3%、31.6%、11.3%和 0.8%的参与者分别达到了一个、两个、三个、四个或五个目标中的任何一个。我们注意到 HbA、血压和胆固醇有相当大的改善，并且发现干预组的参与者在 12 个月时更有可能实现所有三个指标的改善，并且在研究的 28 个月中持续改善[相对风险 2.1（95%CI 1.5，2.8）和 1.8（95%CI 1.5，2.3）]。
干预措施与复合糖尿病质量护理目标的更高实现率和更大改善相关。然而，在这些高风险参与者中，只有很小比例的人达到了完整的目标组，这表明实现多个质量护理目标具有挑战性，可能需要其他方法来缩小差距。
