Kang Hyojung, Kim Soyoun, Malloy Kevin, McMurry Timothy L, Balkrishnan Rajesh, Anderson Roger, McCall Anthony, Sohn Min-Woong, Lobo Jennifer Mason
Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
Department of Public Health Sciences, School of Medicine, University of Virginia, Hospital West, 3rd Floor, Room 3003, PO Box 800717, Charlottesville, VA 22908-0717, USA.
Health Serv Outcomes Res Methodol. 2021 Sep;21(3):324-338. doi: 10.1007/s10742-020-00237-1. Epub 2021 Jan 6.
For patients with diabetes, annual preventive care is essential to reduce the risk of complications. Local healthcare resources affect the utilization of diabetes preventive care. Our objectives were to evaluate the relative efficiency of counties in providing diabetes preventive care and explore potential to improve efficiencies. The study setting is public and private healthcare providers in US counties with available data. County-level demographics were extracted from the Area Health Resources File using data from 2010 to 2013, and individual-level information of diabetes preventive service use was obtained from the 2010 Behavioral Risk Factor Surveillance System. 1112 US counties were analyzed. Cluster analysis was used to place counties into three similar groups in terms of economic wellbeing and population characteristics. Group 1 consisted of metropolitan counties with prosperous or comfortable economic levels. Group 2 mostly consisted of non-metropolitan areas between distress and mid-tier levels, while Group 3 were mostly prosperous or comfortable counties in metropolitan areas. We used data enveopement analysis to assess efficiencies within each group. The majority of counties had modest efficiency in providing diabetes preventive care; 36 counties (57.1%), 345 counties (61.1%), and 263 counties (54.3%) were inefficient (efficiency scores < 1) in Group 1, Group 2, and Group 3, respectively. For inefficient counties, foot and eye exams were often identified as sources of inefficiency. Available health professionals in some counties were not fully utilized to provide diabetes preventive care. Identifying benchmarking targets from counties with similar resources can help counties and policy makers develop actionable strategies to improve performance.
对于糖尿病患者而言，年度预防性护理对于降低并发症风险至关重要。当地的医疗资源会影响糖尿病预防性护理的利用率。我们的目标是评估各县在提供糖尿病预防性护理方面的相对效率，并探索提高效率的潜力。研究对象为美国各县有可用数据的公立和私立医疗服务提供者。利用2010年至2013年的数据从地区卫生资源文件中提取县级人口统计数据，并从2010年行为风险因素监测系统中获取糖尿病预防性服务使用的个人层面信息。对1112个美国县进行了分析。聚类分析用于根据经济状况和人口特征将各县分为三个相似的组。第一组由经济水平繁荣或良好的大都市县组成。第二组主要由处于困境和中等水平之间的非大都市地区组成，而第三组主要是大都市地区繁荣或良好的县。我们使用数据包络分析来评估每组内的效率。大多数县在提供糖尿病预防性护理方面效率一般；第一组、第二组和第三组分别有36个县（57.1%）、345个县（61.1%）和263个县（54.3%）效率低下（效率得分<1）。对于效率低下的县，足部和眼部检查常常被确定为效率低下的根源。一些县现有的卫生专业人员未得到充分利用以提供糖尿病预防性护理。从资源相似的县确定标杆管理目标有助于各县和政策制定者制定可采取行动的战略以提高绩效。
