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Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis.

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العنوان: Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis.
المؤلفون: Lee-Ling Lim, Eric S H Lau, Risa Ozaki, Harriet Chung, Amy W C Fu, Wendy Chan, Alice P S Kong, Ronald C W Ma, Wing-Yee So, Elaine Chow, Kitty K T Cheung, Tiffany Yau, C C Chow, Vanessa Lau, Rebecca Yue, Shek Ng, Benny Zee, William Goggins, Brian Oldenburg, Philip M Clarke, Maggie Lau, Rebecca Wong, C C Tsang, Edward W Gregg, Hongjiang Wu, Peter C Y Tong, Gary T C Ko, Andrea O Y Luk, Juliana C N Chan
المصدر: PLoS Medicine, Vol 17, Iss 10, p e1003367 (2020)
بيانات النشر: Public Library of Science (PLoS), 2020.
سنة النشر: 2020
المجموعة: LCC:Medicine
مصطلحات موضوعية: Medicine
الوصف: BackgroundDiabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings.Methods and findingsThe web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15-1.30) and 0.70 (95% CI 0.66-0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score-matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias.ConclusionsICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings.
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 1549-1277
1549-1676
Relation: https://doaj.org/toc/1549-1277; https://doaj.org/toc/1549-1676
DOI: 10.1371/journal.pmed.1003367
URL الوصول: https://doaj.org/article/992da5105ccb4d43b7e2aa48145f338a
رقم الأكسشن: edsdoj.992da5105ccb4d43b7e2aa48145f338a
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:15491277
15491676
DOI:10.1371/journal.pmed.1003367