应用整群抽样检验技术评价基层医疗中 2 型糖尿病患者的优质护理。

An evaluation of the quality care for type 2 diabetes patients in the primary healthcare using the lot quality assurance sampling technique.

机构信息

Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

BMC Health Serv Res. 2024 Sep 17;24(1):1086. doi: 10.1186/s12913-024-11555-2.

DOI:10.1186/s12913-024-11555-2

PMID:39289707

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11409480/

Abstract

BACKGROUND

Diabetes is the most prevalent metabolic disease globally. Correct and effective healthcare management requires up-to-date and accurate information at the local level. This level of information allows managers to determine whether the health system has achieved its desired goals in this area. This study aimed to evaluate the adequacy and quality of care for Type 2 diabetes mellitus (T2DM) patients using the Lot quality assurance sampling (LQAS) technique to provide evidence for decision-making at the local level, prioritizing and allocating resources.

METHODS

A descriptive-analytical study was conducted in 12 supervision areas (SAs)/health facilities in northwestern Iran involving 240 patients with T2DM in primary health care. The selection of patients and determination of SAs were done randomly using the LQAS technique. Glycated Hemoglobin (HbAc) was used to evaluate patients' blood sugar control in each SA. Multiple linear regression analysis was used to estimate predictors of HbAc in T2DM.

RESULTS

The overall average of HbA1c value was 7.84%. The HbAc level was > 7% in 148 (61.6%) of the patients. Among the 12 SAs, the LQAS identified unacceptable quality of care in 5 SAs. In the final analysis, each unit increase in fasting blood sugar (FBS), High-density lipoprotein (HDL), Low-density lipoprotein (LDL), and Thyroglobulin (TG) values resulted in an increased in HbAc levels by 0.43, 0.183, 0.124, and 0.182 times, respectively. However, with a one-unit increase in the care of a family physician and nutritionist, along with regular physical activity, HbAc levels decreased by - 0.162, -0.74, and - 0.11 times, respectively.

CONCLUSIONS

The quality of care for diabetic patients needs improvement in some SAs. Findings indicated that the LQAS technique effectively identifies centers/areas with substandard diabetes care quality and efficiently allocates resources to those in need. It is recommended to implement corrective measures in areas with inadequate care quality.

摘要

背景

糖尿病是全球最普遍的代谢疾病。正确有效的医疗保健管理需要在当地层面提供最新和准确的信息。这种信息水平可以让管理者确定卫生系统在该领域是否达到了预期目标。本研究旨在使用Lot 质量保证抽样（LQAS）技术评估 2 型糖尿病（T2DM）患者的护理充分性和质量，为当地层面的决策提供证据，优先和分配资源。

方法

在伊朗西北部的 12 个监督区（SA）/卫生机构中进行了一项描述性分析研究，涉及初级保健中 240 名 T2DM 患者。使用 LQAS 技术随机选择患者和确定 SA。糖化血红蛋白（HbA1c）用于评估每个 SA 中患者的血糖控制情况。使用多元线性回归分析估计 T2DM 中 HbA1c 的预测因素。

结果

总体平均 HbA1c 值为 7.84%。148 名（61.6%）患者的 HbA1c 水平>7%。在 12 个 SA 中，LQAS 在 5 个 SA 中发现护理质量不可接受。在最终分析中，空腹血糖（FBS）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和甲状腺球蛋白（TG）每增加一个单位，HbA1c 水平分别增加 0.43、0.183、0.124 和 0.182 倍。然而，家庭医生和营养师的护理增加一个单位，以及定期进行体育锻炼，HbA1c 水平分别降低-0.162、-0.74 和-0.11 倍。