The Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, USA.
National Institute for Health Research, Tehran University of Medical Sciences, Postal address: No 70, Bozorgmehr st, Tehran, Iran.
BMC Health Serv Res. 2021 Aug 31;21(1):896. doi: 10.1186/s12913-021-06932-0.
Facing limited health resources, healthcare providers need to rely on health service delivery models that produce the best clinical outcomes and patient experience. We aimed to contribute to developing a patient experience-based type 2 diabetes service delivery model by identifying operational structures and processes of care that were associated with clinical outcome, health experience, and service experience.
We conducted a cross-sectional survey of type 2 diabetes patients between January 2019 to February 2020. Having adjusted for demand variables, we examined relationships between independent variables (behaviours, services/processes, and structures) and three categories of dependent variables; clinical outcomes (HbA1c and fasting blood glucose), health experience (EuroQol quality of life (EQ-5D), evaluation of quality of life (visual analgene scale of EQ-5D), and satisfaction with overall health status), and service experience (evaluation of diabetes services in comparison with worst and best imaginable diabetes services and satisfaction with diabetes services). We analysed data using multivariate linear regression models using Stata software.
After adjusting for demand variables; structures, diabetes-specific health behaviours, and processes explained up to 22, 12, and 9% of the variance in the outcomes, respectively. Based on significant associations between the diabetes service operations and outcomes, the components of an experience-based service delivery model included the structural elements (continuity of care, redistribution of task to low-cost resources, and improved access to provider), behaviours (improved patient awareness and adherence), and process elements (reduced variation in service utilization, increased responsiveness, caring, comprehensiveness of care, and shared decision-making).
Based on the extent of explained variance and identified significant variables, health services operational factors that determine patient-reported outcomes for patients with type 2 diabetes in Iran were identified, which focus on improving continuity of care and access to providers at the first place, improving adherence to care at the second, and various operational process variables at the third place.
面对有限的卫生资源，医疗保健提供者需要依赖能够产生最佳临床结果和患者体验的卫生服务提供模式。我们旨在通过确定与临床结果、健康体验和服务体验相关的运营结构和护理流程，为开发基于患者体验的 2 型糖尿病服务提供模式做出贡献。
我们在 2019 年 1 月至 2020 年 2 月期间对 2 型糖尿病患者进行了横断面调查。在调整了需求变量后，我们研究了自变量（行为、服务/流程和结构）与三个依赖变量类别之间的关系：临床结果（HbA1c 和空腹血糖）、健康体验（欧洲五维健康量表（EQ-5D）的健康状况）、健康状况满意度）和服务体验（与最差和最佳想象的糖尿病服务相比，对糖尿病服务的评价以及对糖尿病服务的满意度）。我们使用 Stata 软件的多元线性回归模型分析数据。
在调整了需求变量后；结构、特定于糖尿病的健康行为和流程分别解释了结果的 22%、12%和 9%的差异。基于糖尿病服务运营与结果之间的显著关联，基于体验的服务提供模型的组成部分包括结构性要素（连续性护理、任务向低成本资源的重新分配以及获得提供者的机会增加）、行为（提高患者的意识和依从性）和流程要素（减少服务利用的变化、提高响应能力、关怀、护理的全面性和共同决策）。
根据解释方差的程度和确定的显著变量，确定了决定伊朗 2 型糖尿病患者报告结局的卫生服务运营因素，这些因素首先关注改善连续性护理和获得提供者的机会，其次是提高对护理的依从性，其次是各种运营流程变量。
