新近确诊的 2 型糖尿病患者的 "患者报告结果测量 "的意义。

IF 3.5 4区 医学 Q1 HEALTH POLICY & SERVICES
Nura Abdel-Rahman, Orly Manor, Einat Elran, David Siscovick, Ronit Calderon-Margalit
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引用次数: 0

摘要

背景:过去二十年来,糖尿病护理质量的评估主要依赖于临床质量指标。这些指标中并不包括患者报告结果指标(PROMs),而患者报告结果指标可提供患者认为有价值的结果信息。我们旨在研究 PROMs 在 2 型糖尿病护理中的潜在作用,并研究 PROMs 与患者特征和临床质量指标之间的关联:方法:在一家大型医疗计划中对近期(≤ 4 年)确诊的 2 型糖尿病患者(n = 392)进行横断面调查。PROM以两份经过充分验证的问卷为基础,一份是糖尿病问题领域(PAID)单页问卷,用于测量与糖尿病相关的困扰;另一份是PROMIS-10全球健康问卷,共10个项目,用于测量总体健康状况。根据之前对以色列糖尿病患者进行的一项定性研究,还增加了其他项目。调查采用电话访问的方式进行,收集的数据与电子病历相链接。多变量回归模型用于评估社会人口学变量和临床质量指标与 PROMs 的关联:结果:约五分之一的参与者(22%)有严重的糖尿病相关困扰(PAID评分≥40),三分之一的参与者表示对自我管理糖尿病没有信心,约三分之一的参与者表示有性功能障碍。女性、年轻患者和受教育程度低(≤ 12 年)的患者的总体健康状况较差,更有可能经历较高的糖尿病相关困扰,对糖尿病自我管理的信心也较低。有趣的是,所有七项糖尿病质量指标的表现都与总体健康状况较差和糖尿病相关困扰较高有关。值得注意的是,糖化血红蛋白、低密度脂蛋白胆固醇或血压水平与PROMs无关:PROMs提供了患者自我报告健康状况的重要信息,并有可能反映出临床医生无法以其他方式获得的医疗质量的各个方面。因此,使用 PROMs 有可能扩大糖尿病护理的评估范围,促进以患者为中心的护理。我们建议卫生部和健康维护组织的政策制定者采用 PROMs 来评估和改善对 2 型糖尿病患者的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes.

Background: For the past two decades, the assessment of the quality of diabetes care has mostly relied on clinical quality indicators. These have not included Patient-Reported Outcome Measures (PROMs) which provide information on outcomes deemed valuable by patients. We aimed to examine the potential utility of PROMs in type 2 diabetes care and to study the association of PROMs with patients' characteristics and clinical quality indicators.

Methods: A cross-sectional survey of recently (≤ 4 years) diagnosed patients with type 2 diabetes (n = 392) in the setting of a large health plan. PROMs were based on two well-validated questionnaires, the Problem Areas in Diabetes (PAID) one-page questionnaire that measures diabetes-related distress, and the ten item PROMIS-10 global health questionnaire that measures general health. Additional items were added following a previous qualitative study among Israeli patients with diabetes. The survey was carried out using phone interviews, and data collected were linked to the electronic medical records. Multivariable regression models were used to assess the associations of socio-demographic variables and clinical quality indicators with the PROMs.

Results: About a fifth of participants (22%) had high diabetes-related distress (PAID score ≥ 40), a third reported that they did not feel confident in self-management of diabetes and about a third reported having sexual dysfunction. Women, younger patients, and those with a low education level (≤ 12 years) reported worse general health, were more likely to experience high diabetes-related distress, and to have low confidence in diabetes self-management. Interestingly, performance of all seven diabetes quality indicators was associated with worse general health and high diabetes-related distress. Of note, levels of glycated hemoglobin, LDL-cholesterol, or blood pressure were not associated with PROMs.

Conclusions: PROMs provide important information on patient self-reported health status and are likely to reflect aspects of the quality of care that are not otherwise available to clinicians. Thus, the use of PROMs has the potential to expand the evaluation of diabetes care and promote patient-centered care. We recommend that policy-makers in the Ministry of Health and health maintenance organizations implement PROMs for assessing and improving the care for patients with type 2 diabetes.

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来源期刊
CiteScore
6.20
自引率
4.40%
发文量
38
审稿时长
28 weeks
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