Research Western, Western University, London, ON, Canada.
Centre for Outcomes Research & Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
Diabetes Res Clin Pract. 2020 Apr;162:108066. doi: 10.1016/j.diabres.2020.108066. Epub 2020 Feb 8.
TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) partnered with local clinical and community teams in 11 First Nations (FN) communities across Canada to develop quality improvement (QI) initiatives aimed at improving T2DM.
Pre-post mixed-methods case study design was used. The 18-month intervention included community and clinical readiness, development of a community diabetes registry and clinical system, and QI activities. Participants consisted of community members, 18 yrs and older, with diabetes. Changes in clinical outcomes and clinical practice guideline (CPG) recommendations were assessed pre and post intervention using multilevel regression (patients nested within communities) adjusted forindividual andcommunity baseline characteristics.
No significant change in HbA1c orsBP, but a small reduction indBP(-0.75 mmHg, p < 0.05) and LDL (-0.09 mmol/L, p < 0.05) was observed in 2008 adults with T2DM (mean age: 60·5 (SD:14·6) years; female: 57·2%). Individuals not at CPG targets at baseline had significant reductions in: %HbA1c (N = 616): -0.40 (95%CI:-0·55,-0·24),sBP (N = 561): -7·67 mmHg (95%CI:-9·23, -5·72),dBP (N = 291): -7·46 mmHg (95%CI:-8·69, -6·26), LDL (N = 450): -0·37mmo/l (95%CI:-0·44, -0·29).Annual HbA1c (OR: 1·95; 95%CI:1·66, 2·29), BP (OR: 1·78; 95%CI:1·52, 2·09), LDL (OR: 1·27; 95%CI:1·10, 1·47) and CKD screening (OR: 6·37; 95%CI:5·16, 7·92)increased but retinopathy screening decreased (OR: 0·68; 95%CI:0·57, 0·82). No significant change in foot exams (OR: 0·97; 95%CI:0·76, 1·23) or BMI recordings (OR: 0·96; 95%CI:0·82, 1·12) was seen. Overall, individualsweremorelikely to receive ≥75% of CPG recommended services compared to baseline (OR: 1·51; 95%CI:1·27, 1·80).
FORGE AHEAD is the first Canadian study to demonstrate that a FN community-led QI intervention can lead to diabetes improvements.
转型原住民初级保健服务（FORGE AHEAD）与加拿大 11 个原住民社区的当地临床和社区团队合作，制定了旨在改善 2 型糖尿病的质量改进（QI）计划。
采用前后混合方法的病例研究设计。18 个月的干预措施包括社区和临床准备、社区糖尿病登记册和临床系统的开发以及 QI 活动。参与者包括社区成员，年龄在 18 岁及以上，患有糖尿病。使用多层回归（患者嵌套在社区中）在调整个体和社区基线特征后，评估干预前后的临床结果和临床实践指南（CPG）建议。
在 2008 名患有 2 型糖尿病的成年人中，HbA1c 或 sBP 没有显著变化（平均年龄：60.5（SD：14.6）岁；女性：57.2%）。基线时未达到 CPG 目标的个体：%HbA1c（N=616）：-0.40（95%CI：-0.55，-0.24），sBP（N=561）：-7.67mmHg（95%CI：-9.23，-5.72），dBP（N=291）：-7.46mmHg（95%CI：-8.69，-6.26），LDL（N=450）：-0.37mmol/L（95%CI：-0.44，-0.29）。HbA1c 每年（OR：1.95；95%CI：1.66，2.29）、BP（OR：1.78；95%CI：1.52，2.09）、LDL（OR：1.27；95%CI：1.10，1.47）和 CKD 筛查（OR：6.37；95%CI：5.16，7.92）的增加，但视网膜病变筛查减少（OR：0.68；95%CI：0.57，0.82）。脚检（OR：0.97；95%CI：0.76，1.23）或 BMI 记录（OR：0.96；95%CI：0.82，1.12）没有明显变化。总体而言，与基线相比，患者接受≥75% CPG 推荐服务的可能性更高（OR：1.51；95%CI：1.27，1.80）。
FORGE AHEAD 是加拿大第一项表明原住民社区主导的 QI 干预措施可以改善糖尿病的研究。
