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

Autor: Adele Lallo, Federico Rea, Marina Davoli, Lucia Lispi, Rossana DlE PlALMA, Edlira Skrami, Luca Merlino, Flavia Carle, Paola Pisanti, Mirko Di Martino, Giovanni Corrao, Laura Maria Beatrice Belotti
Přispěvatelé: Corrao, G, Rea, F, DI Martino, M, Lallo, A, Davoli, M, DE Palma, R, Belotti, L, Merlino, L, Pisanti, P, Lispi, L, Skrami, E, Carle, F
Rok vydání: 2018
Předmět:
Male
Cohort Studies
chemistry.chemical_compound
0302 clinical medicine
030212 general & internal medicine
Aged
80 and over
education.field_of_study
Health Policy
Vision Tests
composite outcome
Hazard ratio
Periodic examination
Disease Management
General Medicine
Middle Aged
Lipids
Hospitalization
Italy
Creatinine
Cohort
Female
recommendation
Healthcare utilization database
Adult
medicine.medical_specialty
Population
030209 endocrinology & metabolism
03 medical and health sciences
Internal medicine
Diabetes mellitus
Albumins
medicine
Humans
education
Aged
Retrospective Studies
Glycated Hemoglobin
business.industry
Proportional hazards model
Public Health
Environmental and Occupational Health
Retrospective cohort study
medicine.disease
Confidence interval
Population-based cohort study
chemistry
Diabetes Mellitus
Type 2
diabete
Patient Compliance
Glycated hemoglobin
business
Zdroj: International journal for quality in health care : journal of the International Society for Quality in Health Care. 31(6)
ISSN: 1464-3677
Popis: 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.
Databáze: OpenAIRE
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