Davis K C, Cogswell M E, Rothenberg S L, Koplan J P
Prudential Center for Health Care Research, Atlanta, GA 30339, USA.
Public Health Rep. 1998 Jul-Aug;113(4):346-50.
To determine the proportion of patients in a managed care setting who were screened and followed up for high blood cholesterol in accordance with the guidelines from the second report of the National Cholesterol Education Program-Adult Treatment Panel II.
The authors conducted a retrospective review of the medical records of 1004 health plan members ages 40-64 who had been continuously enrolled over a period of five years at one of three Prudential Health-Care sites.
Eighty-four percent of patients in the study group had at least one total blood cholesterol level recorded in their medical records; a high density lipoprotein level was recorded for 67%. Cholesterol screening was highest among patients with a diagnosis of hypercholesterolemia (98%), hypertension (96%), or diabetes (94%) and among patients ages 60-64 (94%). Cholesterol screening did not vary by smoking status. More than 86% of those with a diagnosis of hypercholesterolemia were given dietary counseling, medication, or both.
Compliance with national guidelines in this setting exceeded the Year 2000 goals for lipid management and was comparable with compliance reported in other settings. Routine surveillance of prevention efforts can be a useful way to assess quality of medical care in managed care organizations.
根据国家胆固醇教育计划成人治疗专家组第二次报告的指南，确定管理式医疗环境中接受高血胆固醇筛查及后续跟踪的患者比例。
作者对1004名年龄在40 - 64岁之间的健康计划成员的病历进行了回顾性研究，这些成员在保诚医疗保健的三个地点之一连续登记了五年。
研究组中84%的患者病历中至少记录了一次总血胆固醇水平；67%的患者记录了高密度脂蛋白水平。胆固醇筛查在诊断为高胆固醇血症（98%）、高血压（96%）或糖尿病（94%）的患者以及60 - 64岁的患者（94%）中最高。胆固醇筛查不因吸烟状况而异。超过86%诊断为高胆固醇血症的患者接受了饮食咨询、药物治疗或两者皆有。
在这种环境下对国家指南的遵循情况超过了2000年血脂管理目标，并且与其他环境中报告的遵循情况相当。对预防措施进行常规监测可能是评估管理式医疗组织医疗质量的一种有用方法。
