Department of Pharmacy Practice & Administration, Western University of Health Sciences, Pomona, California.
J Diabetes. 2021 Jan;13(1):78-88. doi: 10.1111/1753-0407.13109. Epub 2020 Sep 13.
This study examined the association between quality of processes of diabetes care in terms of adherence to American Diabetes Association (ADA)-recommended guidelines and health care utilization in patients with diabetes.
Adults with diabetes were identified from the pool of five panels of the Medical Expenditure Panel Survey, a nationally representative US sample, between 2012 and 2017. The Diabetes Care Survey was used to determine adherence to the ADA-recommended guidelines for processes of diabetes care if all of the following were performed annually: glycosylated hemoglobin check, foot examination, dilated eye examination, lipid panel, influenza immunization, blood pressure check, and dental examination. Health care utilization in terms of inpatient hospitalization, and emergency department (ED) and outpatient visits were estimated using two-part hurdle models.
An estimated 26.3 million adults with diabetes were derived from the pooled 5-panel data, of which 7.8% met the ADA-recommended guidelines for processes of diabetes care, and adherence rates of individual recommendations were generally below 50%. Overall, adults who adhered to the ADA-recommendations were older, non-Hispanic white, and married nonsmokers with private insurance and higher income. Mean inpatient hospital stays, ED, and outpatient visits between ADA-adherent vs nonadherent patients were 0.98 vs 1.62 (P < .001), 0.36 vs 0.39 (P = .074), and 17.9 vs 12.8 (P < .001), respectively.
Socioeconomic disadvantage and minority status were linked with nonadherence to the ADA-recommended processes of diabetes care. Adherence to the ADA recommendation was associated with significant reduction in inpatient hospitalization and a trend toward less ED visits. Our findings may apply to the United States and are likely to be different in other parts of the world.
本研究考察了糖尿病治疗过程中的质量与糖尿病患者医疗保健利用之间的关系，该质量是根据对美国糖尿病协会（ADA）推荐指南的遵循程度来评估的。
本研究从 2012 年至 2017 年期间，从五项美国医疗支出调查小组中抽取了成年糖尿病患者作为样本。如果每年都完成以下所有检查，则使用糖尿病护理调查来确定对 ADA 推荐的糖尿病治疗过程指南的遵循情况：糖化血红蛋白检查、足部检查、散瞳检查、血脂检查、流感疫苗接种、血压检查和牙科检查。使用两部分门限模型估计住院、急诊（ED）和门诊就诊的医疗保健利用情况。
从汇总的五组数据中估计有 2630 万成年糖尿病患者，其中 7.8%符合 ADA 推荐的糖尿病治疗过程指南，而个别建议的遵循率通常低于 50%。总体而言，符合 ADA 建议的成年人年龄较大、为非西班牙裔白人、已婚不吸烟者、拥有私人保险和较高收入。与不符合 ADA 建议的患者相比，符合 ADA 建议的患者的平均住院天数、ED 和门诊就诊次数分别为 0.98 天 vs 1.62 天（P < 0.001）、0.36 次 vs 0.39 次（P = 0.074）和 17.9 次 vs 12.8 次（P < 0.001）。
社会经济劣势和少数民族身份与不符合 ADA 推荐的糖尿病治疗过程有关。符合 ADA 建议与住院治疗显著减少和 ED 就诊次数减少趋势相关。我们的研究结果可能适用于美国，而在世界其他地区可能有所不同。
