a longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness一个纵向研究遵守指导方针在糖尿病护理根据不同定义的充分性和及时性.pdfVIP

A Longitudinal Study Examining Adherence to Guidelines in Diabetes Care According to Different Definitions of Adequacy and Timeliness 1,2 1,2 1 1,2 Grigory Sidorenkov , Flora M. Haaijer-Ruskamp , Dick de Zeeuw , Petra Denig * 1 Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, 2 Research Institute SHARE of the Graduate School of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Abstract Background: Performance indicators assessing quality of diabetes care often look at single processes, e.g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways). We assessed quality of diabetes care by looking at single processes versus clinical pathways. In addition, we evaluated the impact of time period definitions on this quality assessment. Methodology: We conducted a cohort study in 2007–2008 using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment) database. Proportions of patients adequately managed for HbA1c, systolic blood pressure (SBP), LDL- cholesterol (LDL-C), and albumin/creatinin ratio (ACR) were calculated for the pathway of (1) risk factor level testing, (2) treatment intensification when indicated, (3) response to treatment evaluation. Strict and wide time periods for each step were defined. Proportions of patients adequately managed regarding the overall pathway and single steps, using strict or wide time periods were compared using odds ratios (OR) with 95% confidence intervals. Findings: Of 11176 patients diagnosed with type 2