中国全科医学 ›› 2024, Vol. 27 ›› Issue (05): 570-576.DOI: 10.12114/j.issn.1007-9572.2023.0369

所属专题: 内分泌代谢性疾病最新文章合集

• 论著·专病管理·糖尿病 • 上一篇    下一篇

基于医疗失效模式与效应分析框架的社区2型糖尿病临床惰性形成原因及对策研究

李殿江1,*(), 潘恩春2, 王苗苗1, 孙中明2, 文进博2, 樊宏1, 沈冲1   

  1. 1.211166 江苏省南京市,南京医科大学公共卫生学院
    2.223001 江苏省淮安市疾病预防控制中心
  • 收稿日期:2023-07-31 修回日期:2023-09-21 出版日期:2024-02-15 发布日期:2023-11-21
  • 通讯作者: 李殿江

  • 作者贡献:李殿江负责研究方案构思与文章撰写;王苗苗负责文献收集、数据整理与分析;潘恩春负责统筹两轮专家咨询的实施;孙中明、文进博负责现场访谈内容记录与梳理;樊宏、沈冲负责专家论证表的设计与修改。
  • 基金资助:
    国家自然科学基金面上项目(71974101); 淮安市卫生健康科研项目(HAWJ201924)

A Study of Root Causes and Countermeasures for Clinical Inertia in Type 2 Diabetes Patients in Community Based on Healthcare Failure Mode and Effect Analysis Framework

LI Dianjiang1,*(), PAN Enchun2, WANG Miaomiao1, SUN Zhongming2, WEN Jinbo2, FAN Hong1, SHEN Chong1   

  1. 1. School of Public Health, Nanjing Medical University, Nanjing 211166, China
    2. Huaian Center for Disease Control and Prevention, Huaian 223001, China
  • Received:2023-07-31 Revised:2023-09-21 Published:2024-02-15 Online:2023-11-21
  • Contact: LI Dianjiang

摘要: 背景 自2009年起,社区2型糖尿病(T2DM)健康管理作为国家基本公共卫生服务项目在全国得到推广实施,但由于临床惰性(即发现问题未能及时采取干预措施)的影响,造成患者血糖长期控制效果不佳,因此如何克服临床惰性以提高血糖控制率是优化糖尿病健康管理所面临的一项重要而紧迫的任务。目的 识别社区T2DM健康管理过程中临床惰性发生的关键失效模式,系统分析关键失效模式的发生原因,并提出相应的干预对策措施。方法 立足社区实情,以医疗失效模式与效应分析(HFMEA)框架为指导,通过实地调研、访谈及文献归纳分析法初步明确社区T2DM健康管理流程、临床惰性发生的原因及干预措施。文献检索时间为2020-01-01—2023-06-30。在此基础上,应用德尔菲法,选择16名专家于2022-01-10—02-25期间进行两轮专家咨询,最终确定社区T2DM健康管理过程中临床惰性发生的关键失效模式、发生原因和干预措施。结果 第一轮和第二轮专家权威系数分别为0.791和0.729。最终通过计算风险优先指数(RPN)量化确定了社区T2DM健康管理过程中临床惰性发生的10个关键失效模式,按RPN从大到小,依次为未(及时)胰岛素治疗、未(及时)戒酒、未(及时)常规转诊、未(及时)戒烟、未(及时)紧急转诊、未(及时)三联治疗、未(及时)控制体质量、未(及时)调整膳食结构、未(及时)二联治疗和未(及时)发现低血糖,并从患者、医生及卫生系统层面阐明了关键失效模式形成的根本原因,制定了针对性的干预措施。结论 制定的临床惰性干预措施具有较高的科学性和权威性,为优化社区T2DM健康管理模式奠定了基础。

关键词: 糖尿病, 2型, 健康管理, 临床惰性, 形成原因, 社区, 医疗失效模式与效应分析

Abstract:

Background

Since 2009, community health management for type 2 diabetes mellitus (T2DM) has been significantly promoted and implemented as a national public health service program. However, the impact of clinical inertia, defined as failure to take timely interventions when therapeutic goals are unmet, hinders the achievement of long-term optimal glycemic control in T2DM patients. Therefore, addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management.

Objective

To identify the key failure modes of clinical inertia in community health management for T2DM, systematically analyze the underlying causes of these failure modes, and propose corresponding intervention measures.

Methods

Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis (HFMEA) framework, a foundational comprehension of community health management processes for T2DM, the root causes of clinical inertia, and prospective intervention measures were obtained through field research, interviews, and literature review from 2020-01-01 to 2023-06-30. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation during 2022-01-10—02-25, to delineate the key failure modes, their root causes, and intervention measures concerning clinical inertia in community health management for T2DM.

Results

The expert authority coefficients for the first and second rounds were 0.791 and 0.729, respectively, ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the risk priority number (RPN) metric and ranked in descending RPN value as follows: untimely insulin treatment, untimely alcohol cessation, untimely routine referral, untimely smoking cessation, untimely emergency referral, untimely triple therapy, untimely weight control, untimely dietary modification, untimely dichotomous therapy, and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients, physicians, and the healthcare system, enabling the formulation of targeted intervention measures.

Conclusion

The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority, providing a robust foundation for enhancing the community health management model for T2DM.

Key words: Diabetes mellitus, type 2, Health management, Clinical inertia, Root causes, Community, Healthcare failure mode and effect analysis