Cowan F J, Warner J T, Lowes L M, Riberio J P, Gregory J W
Department of Child Health, University Hospital of Wales, Cardiff.
Arch Dis Child. 1997 Aug;77(2):109-14. doi: 10.1136/adc.77.2.109.
To define outcome measures for auditing the clinical care of children and adolescents with insulin dependent diabetes mellitus (IDDM) and to assess the benefit of appointing a dedicated paediatric trained diabetes specialist nurse (PDSN).
Retrospective analysis of medical notes and hospital records. Glycaemic control, growth, weight gain, microvascular complications, school absence, and the proportion of children undergoing an annual clinical review and diabetes education session were assessed. The effect of the appointment of a PDSN on the frequency of hospital admission, length of inpatient stay, and outpatient attendance was evaluated.
Children with IDDM were of normal height and grew well for three years after diagnosis, but grew suboptimally thereafter. Weight gain was above average every year after diagnosis. Glycaemic control was poor at all ages with only 16% of children having an acceptable glycated haemoglobin. Eighty five per cent of patients underwent a formal annual clinical review, of whom 16% had background retinopathy and 20% microalbuminuria in one or more samples. After appointing the PDSN the median length of hospital stay for newly diagnosed patients decreased from five days to one day, with 10 of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median of 19 to 10%.
Outcome measures for evaluating the care of children with IDDM can be defined and evaluated. Specialist nursing support markedly reduces the length of hospital stay of newly diagnosed patients without sacrificing the quality of care.
确定用于审核胰岛素依赖型糖尿病（IDDM）儿童和青少年临床护理的结果指标，并评估任命一名经过儿科培训的专职糖尿病专科护士（PDSN）的益处。
对病历和医院记录进行回顾性分析。评估血糖控制、生长发育、体重增加、微血管并发症、缺课情况以及接受年度临床检查和糖尿病教育课程的儿童比例。评估任命PDSN对住院频率、住院时间和门诊就诊率的影响。
IDDM儿童诊断后的前三年身高正常且生长良好，但此后生长发育欠佳。诊断后每年体重增加高于平均水平。各年龄段的血糖控制均较差，只有16%的儿童糖化血红蛋白水平可接受。85%的患者接受了正式的年度临床检查，其中16%的患者在一个或多个样本中出现背景性视网膜病变，20%出现微量白蛋白尿。任命PDSN后，新诊断患者的中位住院时间从5天降至1天，24名儿童中有10名未住院。后者在次年均未住院。没有证据表明PDSN会影响已确诊IDDM儿童的再次住院频率或住院时间。门诊缺勤率从中位值19%降至10%。
可以定义和评估用于评估IDDM儿童护理的结果指标。专科护理支持可显著缩短新诊断患者的住院时间，且不影响护理质量。
