Diler ASLAN, Gamze Can YILMAZTÜRK, Nalan AKALIN, Mehmet Akif BÜYÜKBEŞE, Yurdaer SERMEZ

Diyabet bakım kalitesinin değerlendirilmesinde laboratuvar test sonuçları nasıl kullanılabilir?

Özet Amaç:Diyabet bakım kalitesinin değerlendirilebilmesi için kalite indikatörleri belirlenmektedir. Bazı kalite indikatörleri hasta muayene verilerinden olduğu kadar HbA1c, LDL-Kolesterol, idrarda albumin, kreatinin klirensi veya hesaplanmış glomerüler filtrasyon hızı (eGFR) gibi laboratuvar test sonuçlarından elde edilen sonuç ölçülerinden hesaplanır. Çalışmamızda bu testlerin klinik yararlanım ve diyabet bakım kalitesinin değerlendirilmesinde kullanılma durumunun değerlendirilmesi amaçlandı. Gereç ve yöntem: Diyabet ve komplikasyonlarıyla ilişkili klinik birimlerden ve laboratuvardan oluşturulan ekip çalışma protokolünü hazırladı. Davet edilen 199 kuruluştan üçü çalışmayı yürüttü. Başlangıçta hasta sayısı 243 idi. Klinik muayeneler çalışma başında yapıldı. Hastalar protokole göre altı ay izlendi. Toplanan veriler diyabet bakım kalitesi açısından değerlendirildi. Bulgular: Başlangıçta vücut kitle indeksi (VKİ), kan basınçları, açlık ve tokluk glukoz, HbA1c, HDL-K (kadınlarda), LDL-K düzeylerine göre hedef düzeyi karşılamayan hasta yüzdeleri %40 ile %81 arasındaydı. Altıncı ayda HbA1c için %25e düştü. Ortalama değerler incelendiğinde, hasta grubunda 6 aydaki HbA1c ortalamalarında A, B ve C hastanelerindeki düşüşler ve %95 güven aralıkları, sırasıyla, -0,46 (-0,64 ve 0,88); -1,71 (-2,17 ve -1,25) ve -1,20 (-1,64 ve -0,77) olarak saptandı. Risk grubundaki hasta yüzdesinde başlangıca göre düşüş gözlenemese de T.Kol, HDL-Kol, LDL-Kol, trigliserid ve idrarda Alb. ve kreatinin klirens ortalama düzeylerinde de olumlu yönde değişiklikler saptandı. Sonuç: Çalışmamız diyabet bakım kalitesinin değerlendirilmesinde laboratuvar test sonuçlarından yararlanılmasına örnek uygulamalar ve sonuçlar içermektedir. Ancak ülkemizde henüz uygulanmayan bu tür çalışmalar için çoklu disiplinli ve sistematik bir yapılanma gerekmektedir.

How to laboratory test results can be used in assessing the quality of diabetes care?

Abstract Purpose: The quality indicators (KIs) assessing diabetes care have been developed. Some KIs are estimated from laboratory test results such as glucose (Glu), HbA1c, LDL-Cholesterol (LDL-Chol), urinary albumin (UAlb), creatinine clearance (CC) or estimated glomerular filtration rate (eGFR), as well as patient examinations. In this study, we aimed to evaluate the clinical utility of tests which are used for estimating quality indicators and also how they are being used for assessment of diabetes care. Materials and methods: A study protocol was produced by the project team. 199 health organizations were invited. Three organizations carried out the study; the number of patients was 243, and their clinical examinations were performed at the beginning. The patients were monitored for 6 months. The data obtained were evaluated in the context of clinical utilities of the test results, and diabetes care quality. Results: At the beginning, from 40% to 81% of patients had values outside of the target levels for glucose, HbA1c, LDL-Chol, and HDL-Chol (female). In the sixth month, small changes were determined. Although the average decreases in the HbA1c% values (CI 95%) in all three hospitals were observed as -0,46 (-0,64 to 0,88); -1,71 (-2,17 to -1,25) and -1,20 (-1,64 to -0,77), it can be said that the diabetic care for approximately 50% of diabetic patients should be improved. The similar favorable changes were observed for T.Chol, HDL-Chol, LDL- Chol, triglyceride, UAlb, and CC values.  Conclusion: The results of our study show that periodic evaluations of the results of specific laboratory tests of diabetic patients will be useful for improvement of quality diabetes care. However it is needed to establish a structured systematic assessment programs by the experts from all relevant disciplines.

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