White Perkins Denise, Milan Pam, Miazek Kimberly, Havstad Suzanne, Wegienka Ganesa
Department of Family Medicine, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA.
Department of Population Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA.
Prev Med Rep. 2021 Nov 18;24:101646. doi: 10.1016/j.pmedr.2021.101646. eCollection 2021 Dec.
Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.
糖尿病自我管理教育与支持（DSMES）有助于人们实现最佳疾病控制，但这些服务的利用率往往仍然较低。由医疗服务提供者转介到这些项目的患者，可能会在几个关键步骤中退出项目。本研究对底特律都会区一个单一医疗系统中被转介接受该医疗系统提供的DSMES的3796名糖尿病患者应用分类与回归树分析，以确定那些成功联系上并安排项目入组预约的患者、那些未参加入组预约的患者以及那些开始但未完成个性化DSMES项目的患者的人口统计学模式。43岁以上的白人、之前糖化血红蛋白（A1C）值>8.9的患者以及有医疗补助保险的患者，未成功联系上进行入组预约的比例最高。那些未参加入组预约的患者往往有医疗补助保险、年龄小于48岁且A1C>8.1。在医疗保险或私人保险组中，未参加的患者更可能是女性、黑人且未婚。A1C较低（≤8.3%）的老年男性未完成DSMES计划的比例最低（34.0%）。数据显示，近一半被转介的患者未成功联系上。13.2%的总体低完成率证实了有必要研究预测参与和完成情况的因素。本研究强调了流程改进措施，以改善外展和参与的个性化程度。
