RESUMO
CONTEXT: Hypoglycemia in the outpatient setting has a significant financial impact on the health care system and negative impact on a person's quality of life. Primary care physicians must address a multitude of issues in a visit with a person with type 2 diabetes mellitus (T2DM), often leaving little time to ask about hypoglycemia. OBJECTIVE: To develop quality measures that focus on outpatient hypoglycemia episodes for patients 65 and older with T2DM, which facilitate a clinician's ability to identify opportunities to improve the quality of care and reduce hypoglycemic episodes. PARTICIPANTS AND PROCESS: A technical expert panel established by the Endocrine Society in March 2019, which includes endocrinologists, primary care physicians, a diabetes care and education specialist/pharmacist, and a patient, developed 3 outpatient hypoglycemia quality measures. The measure set is intended to improve quality of care for patients with T2DM who are at greatest risk for hypoglycemia. The measures were available for public comment in July 2019. A fourth measure on shared decision-making was removed from the final measure set based on public feedback. CONCLUSION: A lack of outpatient hypoglycemia measures focusing on older adults with T2DM is a barrier to improving care of people with diabetes and reducing hypoglycemic episodes. This paper provides measure specifications for 3 measures that may be used to focus quality improvement efforts on patients at greatest risk for hypoglycemia.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Endocrinologia/normas , Hipoglicemia/diagnóstico , Hipoglicemiantes/efeitos adversos , Guias de Prática Clínica como Assunto/normas , Qualidade de Vida , Idoso , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Prognóstico , Sociedades MédicasRESUMO
Because stroke is among the leading causes of death, disability, hospitalizations, and healthcare expenditures in the United States, there is interest in reporting outcomes for patients hospitalized with acute ischemic stroke. The American Heart Association/American Stroke Association, as part of its commitment to promote high-quality, evidence-based care for cardiovascular and stroke patients, fully supports the development of properly risk-adjusted outcome measures for stroke. To accurately assess and report hospital-level outcomes, adequate risk adjustment for case mix is essential. During the development of the Centers for Medicare & Medicaid Services 30-day stroke mortality and 30-day stroke readmission measures, concerns were expressed that these measures were not adequately designed because they do not include a valid initial stroke severity measure, such as the National Institutes of Health Stroke Scale. These outcome measures, as currently constructed, may be prone to mischaracterizing the quality of stroke care being delivered by hospitals and may ultimately harm acute ischemic stroke patients. This article details (1) why the Centers for Medicare & Medicaid Services acute ischemic stroke outcome measures in their present form may not provide adequate risk adjustment, (2) why the measures as currently designed may lead to inaccurate representation of hospital performance and have the potential for serious unintended consequences, (3) what activities the American Heart Association/American Stroke Association has engaged in to highlight these concerns to the Centers for Medicare & Medicaid Services and other interested parties, and (4) alternative approaches and opportunities that should be considered for more accurately risk-adjusting 30-day outcomes measures in patients with ischemic stroke.
Assuntos
Comitês Consultivos/normas , Centers for Medicare and Medicaid Services, U.S./normas , Avaliação de Resultados em Cuidados de Saúde/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral , American Heart Association , Humanos , Estados UnidosAssuntos
Comitês Consultivos/tendências , American Heart Association , Avaliação da Deficiência , Sociedades Médicas/tendências , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/tendências , Humanos , Mortalidade/tendências , Acidente Vascular Cerebral/diagnóstico , Estados Unidos/epidemiologiaAssuntos
American Heart Association , Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/métodos , Satisfação do Paciente , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Comportamento do Consumidor , Promoção da Saúde/tendências , Humanos , Parcerias Público-Privadas/tendências , Fatores de Risco , Resultado do Tratamento , Estados UnidosRESUMO
The American Heart Association's (AHA's) mission is "to build healthier lives, free of cardiovascular diseases and stroke." This first article in a 2-part series will serve to present an overview of the work the AHA has undertaken to translate evidence into practice for healthcare professionals. It describes the extensive work of the AHA to support and further the delivery of evidence-based medicine, which includes the following: (1) supporting scientific discovery and the next generation of healthcare professionals and researchers; (2) disseminating scientific information; (3) developing evidence-based guidelines and statements; (4) creating and advocating for the implementation of performance indicators/measures; (5) developing clinical decision support and quality improvement tools; and (6) developing directed-cause campaigns, all of which can lead to improved patient care. This article also discusses the need for novel approaches and some of the AHA's evolving strategies to help address gaps in care. The second article, which will be published shortly after this one, will examine the AHA's efforts to engage and empower healthcare consumers to become more involved with their own health and health care.
