Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.
Department of Public Health Solutions, Finnish Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.
BMC Fam Pract. 2020 Dec 4;21(1):253. doi: 10.1186/s12875-020-01324-5.
Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland.
The data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012-2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups.
The proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5-6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2-7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p.
The achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.
循证指南包括具体的治疗目标，可作为评估医疗服务和糖尿病护理质量的过程和结果指标。可以通过监测系统层面上护理指标的纵向趋势来评估质量改进。本研究的目的是描述芬兰北卡累利阿地区 2 型糖尿病患者的护理过程和结果的趋势。
数据包括在 2012-2017 年期间在北卡累利阿使用初级或专科护理服务的所有 2 型糖尿病成年人（使用 ICD-10 代码从电子健康记录中识别）。使用测量活动、治疗水平以及 HbA1c 和 LDL 的治疗目标达标情况作为护理指标来评估糖尿病护理。使用广义估计方程的逻辑和线性模型来评估年份、性别和年龄组之间的差异。
在五年的随访中，HbA1c 的年度测量比例在 75.8%至 78.1%之间，LDL 的年度测量比例在 67.4%至 69.1%之间。平均水平的变化适中：HbA1c 增加 0.2%（2mmol/mol），LDL 降低 0.1mmol/l。尽管如此，HbA1c 治疗目标达标率从 72.7%降至 67.3%（年龄调整下降：5.7%，95%CI：4.5-6.9），LDL 治疗目标达标率从 53.4%升至 59.5%（年龄调整增加：5.6%，95%CI：4.2-7.0）。与男性相比，女性接受测量和达到 HbA1c 目标水平的频率更高。相反，男性达到 LDL 目标水平的频率高于女性，性别之间的年龄调整差异从 7.9%增至 11.7%。
北卡累利阿在 2 型糖尿病护理方面的成果非常好，但在随访期间没有观察到明显改善。HbA1c 水平呈上升趋势，LDL 水平呈下降趋势，表明 LDL 管理质量有所提高，但在进一步改善血糖控制方面仍面临挑战。
