Association Between Performance Measures and Glycemic Control Among Patients With Diabetes in a Community-wide Primary Care Cohort.
BACKGROUND: : Performance measures are used for assessing quality of care. Higher performance shown by these measures is expected to reflect better care, but little is known whether they predict better patient outcomes. OBJECTIVE: : To assess the predictive value of performance measures of glucose m...
| Publicado en: | Medical Care Vol. 51; no. 2; pp. 172 - 180 |
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| Autores principales: | , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
2013 Feb
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108019214&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 108019214 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00257079 21B jtl: Medical Care issn: 00257079 maglogo: N pubinfo: dt: 2013 Feb vid: 51 iid: 2 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 108019214 108019214 2011900960 10.1097/MLR.0b013e318277eaf5 NLM23222526 108019214 ppf: 172 ppct: 8 formats: tig: atl: Association Between Performance Measures and Glycemic Control Among Patients With Diabetes in a Community-wide Primary Care Cohort. aug: au: Sidorenkov G Voorham J Haaijer-Ruskamp FM de Zeeuw D Denig P affil: Department of Clinical Pharmacology tResearch Institute SHARE of the Graduate School of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. sug: subj: Diabetes Mellitus, Type 2 Therapy Outcomes (Health Care) Primary Health Care Quality of Health Care Aged Biological Markers Blood Blood Glucose Analysis Prospective Studies Comorbidity Diabetes Mellitus, Type 2 Epidemiology Disease Management Female Glycated Hemoglobin Analysis Human Linear Regression Male Netherlands Predictive Value of Tests Aged: 65+ years Female Male ab: BACKGROUND: : Performance measures are used for assessing quality of care. Higher performance shown by these measures is expected to reflect better care, but little is known whether they predict better patient outcomes. OBJECTIVE: : To assess the predictive value of performance measures of glucose management on glycemic control, and evaluate the impact of patient characteristics on this association. RESEARCH DESIGN: : Cohort study (2007-2009). SUBJECTS: : A total of 15,454 type 2 diabetes patients (mean age, 66.5 y; 48% male) from the GIANTT cohort. MEASURES: : We included performance measures assessing frequency of HbA1c monitoring, glucose-lowering treatment status, and treatment intensification. Associations between performance and glycemic control were tested using multivariate linear regression adjusted for confounding, reporting estimated differences in HbA1c with 95% confidence intervals (CI). Impact of patient characteristics was examined through interactions. RESULTS: : Annual HbA1c monitoring was associated with better glycemic control when compared with no such monitoring (HbA1c -0.29%; 95% CI -0.37, -0.22). This association lost significance in patients with lower baseline HbA1c, older age, and without macrovascular comorbidity. Treatment status was associated with better glycemic control only in patients with elevated baseline HbA1c. Treatment intensification after elevated HbA1c levels was associated with better glycemic control compared with no intensification (HbA1c -0.21; 95% CI -0.26, -0.16). CONCLUSIONS: : Performance measures of annual HbA1c monitoring and of treatment intensification did predict better patient outcomes, whereas the measure of treatment status did not. Predictive value of annual monitoring and of treatment status varied across patient characteristics, and it should be used with caution when patient characteristics cannot be taken into account. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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