背景:2型糖尿病是墨西哥的主要公共卫生问题,因为它的高患病率和未来几年对这种疾病的预测。关于与慢性病相关的多学科护理的研究结果已被证明是有效的,基于以患者为中心的结果的测量,糖尿病患者综合护理中心(CAIPaDi)是一项多学科计划,旨在减少糖尿病并发症。本案例研究旨在说明实施健康结果测量的结果,并证明通过以患者为中心的方法建立综合护理模型的有益效果。
方法:对2013年至2023年在CAIPaDi计划中治疗的2型糖尿病患者的综合护理指标进行了描述性分析。结果是根据国际健康结果测量联盟(ICHOM)提出的糖尿病标准结果集构建的。
结果:完成了为期五年的咨询基线和预期注册,符合ICHOM集26个指标中的25个。在糖尿病控制中,56.5%的患者A1c≤7%,87.9%血压≤130/80mmHg,60.9%的人患有LDL-胆固醇<100mg/dl,在年度咨询期间,肥胖率从42.19%下降到30.6%。首次就诊前诊断时间较短是整体改善计划依从性的关键(P=0.02)。在急性事件中,仅2例患者发生高血糖危象,8例患者发生严重低血糖.对于慢性并发症,没有发生下肢截肢。心血管结局发生率<1%。对牙周病进行了分析,牙周炎从82.9%下降到78.7%。死亡率报告很低,COVID-19是主要的死亡原因。患者报告的结果显示焦虑减少,抑郁症,和随访期间的糖尿病困扰。
结论:注册护理质量指标在综合护理计划中是可行的。它可以改善医疗,心理健康,和2型糖尿病患者的生活方式结局,并为规划健康计划提供相关数据。在计划依从性之前进行快速诊断对于患者的整体改善至关重要。
BACKGROUND: Type 2 diabetes is a major public health issue in Mexico due to its high prevalence and its projection for the coming years for this disease. Findings on multidisciplinary care related to chronic diseases have proven effective, based on measurement of patient-centered outcomes, The Center of Comprehensive Care for Patients with Diabetes (CAIPaDi) is a multidisciplinary program focused on reducing diabetes complications. This
case study aims to illustrate the results of implementing health outcomes measurements and demonstrate the beneficial effects of establishing a comprehensive model of care through a patient-centered approach.
METHODS: A descriptive analysis of the comprehensive care indicators of patients with type 2 diabetes treated in the CAIPaDi program between 2013 and 2023 was conducted. The results were structured according to the standard set of outcomes for diabetes proposed by the International Consortium for Health Outcomes Measurements (ICHOM).
RESULTS: The baseline and prospective registration of consultations was completed for five years, complying with 25 of the 26 indicators of the ICHOM set. In diabetes control, 56.5% of patients had A1c ≤ 7%, 87.9% had BP ≤ 130/80 mmHg, 60.9% had LDL-cholesterol < 100 mg/dl, and obesity rates decreased from 42.19% to 30.6% during annual consultations. Fewer years of diagnosis before the first visit is key to overall improvement in program adherence (P = 0.02). In acute events, a hyperglycemic crisis occurred in only two cases and severe hypoglycemia episodes in 8 patients. For chronic complications, no lower limb amputations occurred. Cardiovascular outcomes occurred in < 1%. Periodontal disease was analyzed, and periodontitis decreased from 82.9% to 78.7%. Mortality
reports were low, with COVID-19 being the main cause of death. Patient-reported outcomes demonstrated reductions in anxiety, depression, and diabetes distress during follow-up.
CONCLUSIONS: Registering quality-of-care indicators is feasible in a comprehensive care program. It allows improving the medical, mental health, and lifestyle outcomes of patients with type 2 diabetes and provides relevant data for planning health programs. A quick diagnosis before program adherence is crucial for overall improvement in patients.