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Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients.

机译：新的老年糖尿病护理指南对老年患者护理质量评估的意义。

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BACKGROUND: Current approaches to assessing quality of diabetes care do not account for the heterogeneity of older patients. OBJECTIVE: We sought to compare conclusions regarding adequacy of glucose and blood pressure control using current quality assessment approaches and a stratified approach based on geriatric care guidelines. DESIGN: This was a cross-sectional evaluation of diabetes care. SUBJECTS: We studied patients older than 65, living with diabetes (n = 554) attending clinics of an academic medical center. MEASUREMENTS: We measured the proportion of patients with and without markers of poor health (life expectancy < or = 5 years, age > or = 85, 4-6 activities of daily living dependencies, or Charlson Comorbidity Index Score > or = 5) achieving treatment goals. RESULTS: Under general population goals (glycosylated hemoglobin [HbA1C] < or = 6.5% or < 7%; systolic blood pressure [SBP] < 130 mm Hg), a small proportion of our subjects met glucose (24-36%) or SBP control (30%) targets. Under new guidelines, less-intense targets (HbA1C < or = 8%, SBP < 140 mm Hg) would be applied to patients with diminished health, with general population goals reserved for healthier patients. With this stratified approach, the proportion of sicker patients achieving their specified glucose (61-83%) and SBP goals (37-64%) generally was high, depending on the criteria for poor health, whereas the proportion of healthier patients achieving their goals remained low. CONCLUSIONS: A stratified approach to assessing the quality of diabetes care leads to distinct care conclusions for older patients with and without markers of diminished health. An approach to quality assessment and quality improvement that acknowledges patient heterogeneity could help ensure the clinical relevance of such efforts for older patients.
机译：背景：目前评估糖尿病护理质量的方法不能解决老年患者的异质性。目的：我们试图比较使用当前质量评估方法和基于老年护理指南的分层方法得出的关于血糖和血压控制是否适当的结论。设计：这是对糖尿病护理的横断面评估。受试者：我们研究了在学术医疗中心门诊接受治疗的65岁以上，糖尿病患者（n = 554）。测量：我们测量了有或没有健康不良指标（预期寿命<或= 5岁，年龄>或= 85、4-6日常依赖的生活活动或Charlson合并症指数得分>或= 5）的患者所达到的比例治疗目标。结果：在一般人群目标（糖基化血红蛋白[HbA1C] <或= 6.5％或<7％;收缩压[SBP] <130 mm Hg）下），我们的一小部分受试者达到了葡萄糖（24-36％）或SBP控制（30％）目标。根据新的指南，健康程度降低的患者应采用较弱的目标（HbA1C <或= 8％，SBP <140毫米汞柱），而总体人群目标则保留给健康的患者。采用这种分层方法，根据健康状况不佳的标准，达到指定血糖水平（61-83％）和SBP目标（37-64％）的患病患者比例通常很高，而达到目标的健康患者比例较高保持低位。结论：一种评估糖尿病护理质量的分层方法可以为有或没有健康下降迹象的老年患者提供不同的护理结论。承认患者异质性的质量评估和质量改进方法可以帮助确保此类工作对老年患者的临床意义。

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