Long-term quality-of-care summary score predicts the occurrence of chronic kidney disease in type 2 diabetic patients

Abstract

Background: Diabetes mellitus is at top 5 of leading causes of death in Taiwan for 30 years Patients with diabetes are at high risk of causing multiple complications But little is known about whether adherence to process or intermediate outcome indicators recommendation is effective in predicting the occurrence of chronic kidney disease (CKD) in type 2 diabetic patients The aim of study was to investigate whether adherence to frequency of HbA1c test recommendation and a quality of care summary score is able to predict the occurrence of CKD in type 2 diabetic patients Methods: From 1999 to 2003 incident type 2 diabetes patients were identified from Longitudinal Cohort of Diabetes Patients database of National Health Insurance program and medical records of a medical center in Taiwan and followed up to 2011 It is recommended that HbA1c test was performed at least twice a year The long-term and comprehensive quality-of-care summary score were calculated by using process and intermediate outcome indicators (HbA1c blood pressure low-density lipoprotein cholesterol microalbuminuria foot exam and eye exam) in the last 3 years before censored date with scores ranged from 0 to 45 Cox proportional hazard regression model was employed to evaluate the association between diabetic care and CKD Results: Overall 4 754 patients were enrolled of whom 1 407 developed CKD events after a mean follow-up of 9 06 years The average age was 55 3 years old and 54 8 % were male The adjusted hazard risk (HR) for CKD for those adherence to proposed HbA1c test guideline was 0 59 (95% confidence interval (CI= 0 51-0 68) compared to patients with poor adherence (<2 times/year) On the other hand the adjusted HR for CKD for those patients with a score of ? 25 and 10-20 were 0 42 (95% CI= 0 32-0 56) and 0 85 (95% CI= 0 76-0 95) respectively compared to patients with score of ? 5 Conclusion: Adherence to recommended HbA1c test significantly decreases the occurrence of CKD in diabetic patients The quality of care summary score is reversely associated with the occurrence of CKD The scoring system which contains process and intermediate outcome indicators may be used to predict the occurrence of CKD in type 2 diabetic patients

Date of Award	2014 Aug 28
Original language	English
Supervisor	Chih-Ching Chang (Supervisor)