Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2020 Feb 6;10(2):e033291. doi: 10.1136/bmjopen-2019-033291.
This study aimed to: (1) explore whether the quality of overall care for older people with diabetes is differentially affected by types and number of comorbid conditions and (2) examine the association between process of care measures and the likelihood of all-cause hospitalisations.
A population-based, retrospective cohort study.
The province of Ontario, Canada.
We identified 673 197 Ontarians aged 65 years and older who had diabetes comorbid with hypertension, chronic ischaemic heart disease, osteoarthritis or depression on 1 April 2010.
The study outcome was the likelihood of having at least one hospital admission in each year, during the study period, from 1 April 2010 to 3 March 2014. Process of care measures specific to older adults with diabetes and these comorbidities, developed by means of a Delphi panel, were used to assess the quality of care. A generalised estimating equations approach was used to examine associations between the process of care measures and the likelihood of hospitalisations.
The study findings suggest that patients are at risk of suboptimal care with each additional comorbid condition, while the incidence of hospitalisations and number of prescribed drugs markedly increased in patients with 2 versus 1 selected comorbid condition, especially in those with discordant comorbidities. The median continuity of care score was higher among patients with diabetes-concordant conditions compared with those with diabetes-discordant conditions, and it declined with additional comorbid conditions in both groups. Greater continuity of care was associated with lower hospital utilisation for older diabetes patients with both concordant and discordant conditions.
There is a need for focusing on improving continuity of care and prioritising treatment in older adults with diabetes with any multiple conditions but especially in those with diabetes-discordant conditions (eg, depression).
本研究旨在：（1）探讨老年糖尿病患者的整体护理质量是否因合并症的类型和数量而存在差异；（2）研究护理过程措施与全因住院的相关性。
基于人群的回顾性队列研究。
加拿大安大略省。
我们确定了 2010 年 4 月 1 日患有糖尿病合并高血压、慢性缺血性心脏病、骨关节炎或抑郁症的 673197 名 65 岁及以上的安大略省居民。
研究结果为 2010 年 4 月 1 日至 2014 年 3 月 3 日期间，每年至少有一次住院的可能性。使用德尔菲小组制定的针对老年糖尿病患者及其合并症的特定护理过程措施来评估护理质量。使用广义估计方程方法来研究护理过程措施与住院可能性之间的相关性。
研究结果表明，随着合并症数量的增加，患者的护理质量可能会受到影响，而在患有 2 种与 1 种选定合并症的患者中，住院率和处方药物数量显著增加，尤其是在合并症不一致的患者中。与患有糖尿病不一致合并症的患者相比，患有糖尿病一致合并症的患者的连续性护理评分中位数更高，且在两组中，随着合并症数量的增加，连续性护理评分逐渐降低。连续性护理的增加与老年糖尿病患者（无论合并症一致还是不一致）的住院利用率降低相关。
需要重点关注提高连续性护理质量，并优先考虑治疗患有多种合并症的老年糖尿病患者，尤其是患有糖尿病不一致合并症的患者（例如，抑郁症）。
