Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations

被引：25

作者：

Corrao, Giovanni ^{[1
,2
]}

Rea, Federico ^{[1
,2
]}

Di Martino, Mirko ^{[3
]}

Lallo, Adele ^{[3
]}

Davoli, Marina ^{[3
]}

De Palma, Rossana ^{[4
]}

Belotti, Laura ^{[4
]}

Merlino, Luca ^{[5
]}

Pisanti, Paola ^{[6
]}

Lispi, Lucia ^{[6
]}

Skrami, Edlira ^{[1
,7
]}

Carle, Flavia ^{[1
,7
]}

Arca, A. ^{[6
]}

Bellentani, D. ^{[6
]}

Bruno, V ^{[6
]}

Carle, F. ^{[6
]}

De Feo, A. ^{[6
]}

Lispi, L. ^{[6
]}

Marinacci, C. ^{[6
]}

Miceli, M. ^{[6
]}

Masullo, M. ^{[6
]}

Pisanti, P. ^{[6
]}

Visca, M. ^{[6
]}

Zanini, R. ^{[6
]}

Belotti, L.

De Palma, R.

Di Felice, E.

Davoli, M.

Di Martino, M.

Fusco, D.

Lallo, A.

Agnello, A.

Merlino, L.

Scire, C. A.

Scondotto, S.

Addario, Pollina W.

Francesconi, P.

Roti, L.

Braga, M. ^{[8
]}

Cosentino, M. ^{[8
]}

Marvulli, M. G. ^{[8
]}

Martini, N. ^{[9
]}

Pedrini, A. ^{[9
]}

Maggioni, A. ^{[10
]}

Corrao, G. ^{[11
]}

Rea, F. ^{[11
]}

机构：

[1] Natl Ctr Healthcare Res & Pharmacoepidemiol, I-20126 Milan, Italy

[2] Univ Milano Bicocca, Dept Stat & Quantitat Methods, Via Bicocca Arcimboldi 8,Edificio U7, I-20126 Milan, Italy

[3] Lazio Reg Hlth Serv, Dept Epidemiol, I-00147 Rome, Italy

[4] Emilia Romagna Reg Hlth Serv, Author Healthcare & Welf, I-40127 Bologna, Italy

[5] Lombardy Reg Hlth Serv, Epidemiol Observ, I-20124 Milan, Italy

[6] Italian Hlth Minist, Dept Hlth Planning, I-00144 Rome, Italy

[7] Polytech Univ Marche, Ctr Epidemiol & Biostat, I-60126 Ancona, Italy

[8] Natl Agcy Reg Hlth Serv, Rome, Italy

[9] Cineca, CORE, Bologna, Italy

[10] ANMCO Natl Assoc Hosp Cardiologists Study Ctr, Florence, Italy

[11] Univ Milano Bicocca, Lab Healthcare Res & Pharmacoepidemiol, Milan, Italy

来源：

INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE | 2019年 / 31卷 / 06期

关键词：

diabetes; healthcare utilization database; population-based cohort study; recommendations; periodic examinations; composite outcome; CARDIOVASCULAR RISK-FACTORS; DISEASE MANAGEMENT; UNITED-STATES; QUALITY; CARE; ASSOCIATION; METAANALYSIS; ADULTS;

D O I：

10.1093/intqhc/mzy186

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes. Design: A retrospective cohort study was carried out from 2010 to 2015. Setting: Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens. Participants: The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort. Interventions: Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded. Main outcomes measures: A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. Results: Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6-24%) and 20% (7-28%) were observed for those who adhered to just some and almost all recommendations, respectively. Conclusions: Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.

引用

页码：464 / 472

页数：9

共 36 条

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