Peters A L, Legorreta A P, Ossorio R C, Davidson M B
Division of Endocrinology, University of California Los Angeles Department of Medicine 90095-1693, USA.
Diabetes Care. 1996 Jun;19(6):601-6. doi: 10.2337/diacare.19.6.601.
To document the quality of diabetes care provided to patients in a large health maintenance organization (HMO) from 1 January 1993 to 1 January 1994 and compare it to the standards of the American Diabetes Association (ADA).
To meet a Health Plan and Employer Data Information Set (HEDIS) requirement, a major HMO in California identified 14,539 members with diabetes and randomly selected 384 individuals for review. Charts were available on 353 of these patients, and after obtaining the information for the HEDIS review, additional information was extracted from the charts by an outside chart reviewer. This data set was used for an analysis of the quality of diabetic care provided by the participating medical groups to these HMO members during 1 year. Documentation of follow-up and measures of glycemic and lipid control was examined both for absolute values and for the frequency of measurement over the year. These results were compared to the ADA standards of care.
Although patients averaged 4.5 visits to their primary care physicians (PCPs) over the year, 21% had one or fewer visits per year. Glycated hemoglobin levels were not documented in 56% of patients (ADA recommends two to four measurements per year), and of those with a glycated hemoglobin level measured. 39% had at least one value > or = 10%. Fasting plasma glucose concentrations were not documented in 65% of patients (four to six per year recommended). Foot exams (which should be performed at each regular visit) were not documented for 94% of patients. Urine protein measurements were not performed in 52% of patients. Additionally, many patients had elevated and untreated lipid abnormalities.
In spite of the frequency of PCP visits during the year for many of these patients, diabetes management was inadequate. This lack of adequate preventive care will lead to an increased risk of the development of the acute and chronic complications of diabetes, creating an even greater future burden on the health care system and negative consequences for patients.
记录1993年1月1日至1994年1月1日期间，一家大型健康维护组织（HMO）为患者提供的糖尿病护理质量，并将其与美国糖尿病协会（ADA）的标准进行比较。
为满足健康计划与雇主数据信息集（HEDIS）的要求，加利福尼亚州的一家大型HMO确定了14539名糖尿病患者，并随机选择384人进行审查。其中353名患者有病历，在获取用于HEDIS审查的信息后，外部病历审查员从病历中提取了更多信息。该数据集用于分析参与的医疗团队在1年期间为这些HMO成员提供的糖尿病护理质量。对随访记录以及血糖和血脂控制指标进行了绝对值和全年测量频率的检查。将这些结果与ADA的护理标准进行比较。
尽管患者一年中平均看了4.5次初级保健医生（PCP），但21%的患者每年就诊次数为1次或更少。56%的患者未记录糖化血红蛋白水平（ADA建议每年测量2至4次），在测量了糖化血红蛋白水平的患者中，39%至少有一次测量值≥10%。65%的患者未记录空腹血糖浓度（建议每年测量4至6次）。94%的患者未记录足部检查（每次定期就诊时都应进行）。52%的患者未进行尿蛋白测量。此外，许多患者存在血脂异常且未得到治疗。
尽管这些患者中有许多人在一年中频繁就诊于初级保健医生，但糖尿病管理仍不充分。这种缺乏充分预防护理的情况将导致糖尿病急性和慢性并发症发生风险增加，给医疗保健系统带来更大的未来负担，并给患者带来负面影响。
