IMPROVING DIABETES CARE FOR ADULTS A Population-：提高成人糖尿病护理人口

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1、IMPROVINGDIABETESCAREFORADULTS:APopulation-BasedApproachPatrickJ.O’Connor,MD,MPHSeniorClinicalInvestigatorHealthPartnersResearchFoundationToday’sObjectivesLeadershipandResources:TheBurdenofDiabetesandtheCostofDoingNothingPopulationHealthImpactandCosto

2、fCompetingDiabetesImprovementPrioritiesThe“EnhancedPrimaryCareModel”ResultsandFutureChallengesCDC,1998.BurdenofDiabetesintheUSMorbidityandMortalityMortality:#3cause,with182,000deathseachyearPrevalencedoublingevery10-15yearsThedeathrateinthediabeticpopu

3、lationisslowlydecreasingformenbutincreasingforwomen70%ofdeathsinadultswithDMarerelatedtoMIorCVAClinicaltrialsprovideevidencethatcontrolofhyperglycemia,dyslipidemia,andhypertensionanduseofASAlowertheriskofmacroandmicrocomplications.PrimaryPreventionofTy

4、pe2DiabetesPhysicalActivityWeightManagementFinnishStudy57%ReductioninIncidencemeanagearound60yearswithIGTdietaryinstruction8weeklysessions,thenq3mostructuredphysicalactivity3xaweeklostabout5Kg.EconomicBurdenofDiabetesinAdultsTheCostofDoingNothingCHD&D

5、MDMonlyHBA1cSelectingImprovementGoalsAllGoalsAreNotEqualPrioritizingDiabetesTreatmentGoalsGapAnalysisConsiderPopulationHealthBenefits--NNT,EventsConsiderIncrementalDirectCoststoPayersClinicalStrategies:GlycemiccontrolLipidcontrolBloodpressurecontrolAsp

6、irinusePercentofAdultDiabetesPatientsNOTatGoalNumberNeededtoTreatfor5YearstoPreventProgressionofOneMicrovascularComplication2872NNT-10/5mmHg-1%HBA1cMicroEventsAverted1075614RelativeImpactofVariousDMImprovementStrategiesonPopulationHealthOutcomesEventsA

7、vertedper10,000AdultswithDMOver5YearsTimeNumberNeededtoTreatfor5YearstoPreventOneHeartAttackorStroke612204060MacroEventsAverted5002502001115850RelativeImpactofVariousDMImprovementStrategiesonPopulationHealthOutcomesEventsAvertedper10,000AdultswithDMOve

8、r5YearsTimeDirectCostsofDMImprovementStrategies5-YearNetCosttoHealthPlanforEvery10,000AdultswithDiabetesforSelectedDiabetesCareImprovementStrategies(IncreasedTreatmentCosts-SavingsfromAvertedEvents)DiabetesImprovementGoalsVariousevidenc