ABSTRACT
Diabetes is an ambulatory care-sensitive condition and a high quality primary care or risk factor control can lead to a decrease in the risk of non-elective hospitalisations while ensuring continuity of care with usual primary care teams. AIMS AND METHODS: In this before and after study, eight primary care practices providing a newer enhanced diabetes model of care in Leicester UK, were compared with matched neighbouring practices with comparable demographic features providing a more expensive integrated specialist-community care diabetes service. The primary outcome at twelve months was to demonstrate equivalence in non-elective bed days. The enhanced practices had primary care physicians and nurses with an interest in diabetes who attended monthly diabetes education meetings and provided care plans and audits. The control practices provided an integrated primary-specialist care service. RESULTS: The difference between the mean change in the non-elective bed days from baseline and at follow up in core and enhanced practices was not statistically significant (mean=2.20 per 100 patients, 95% CI=-0.92 to 5.31 per 100 patients, p=0.14). The analogous change for first outpatients' attendance were 0.23 per 100 patients (95% CI=-0.47 to 0.52 per 100 patients p=0.92) and for diabetes related complications admissions was 0.30 per 100 patients (95% CI=-0.85 to 1.45 per 100 patients p=0.55). CONCLUSION: A model of enhanced primary care based diabetes care appears unlikely to increase hospitalisations, outpatients' attendance or admissions for diabetes related complications.
Subject(s)
Community Health Services/organization & administration , Delivery of Health Care, Integrated/organization & administration , Diabetes Mellitus/therapy , Primary Health Care/organization & administration , Process Assessment, Health Care , Adolescent , Adult , Aged , Diabetes Mellitus/diagnosis , England , Female , Humans , Length of Stay , Male , Middle Aged , Patient Admission , Patient Care Team/organization & administration , Program Evaluation , Socioeconomic Factors , Time Factors , Treatment Outcome , Young AdultABSTRACT
Multiframe blind deconvolution - the process of restoring resolution to blurred imagery when the precise form of the blurs is unknown - is discussed as an estimation-theoretic method for improving the resolving power of ground-based telescopes used for space surveillance. The imaging problem is posed in an estimation-theoretic frame- work whereby the object's incoherent scattering function is estimated through the simultaneous identication and correction of the distorting effects of atmospheric turbulence. An iterative method derived via the expectation-maximization (EM) procedure is reviewed, and results obtained from telescope imagery of the Hubble Space Telescope are presented.
