糖尿病Triangle分层分级管理流程的构建  

Construction of Triangle hierarchical classification management process in diabetes mellitus

作　　者：杨小玲[1] 袁丽[1] 古艳[1] 叶子激[1] 李饶[1] 武仁华[1] Fang Xiaoling;Yuan Li;Gu Fan;Ye Ziwei;Li Rao;Wu Renhua(Department of Endocrinology, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院内分泌代谢科,成都610041

出　　处：《中华糖尿病杂志》2018年第5期327-333,共7页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的建立一个适用于非住院糖尿病患者自我管理教育与支持的分层评估、分级干预的规范流程。方法以Triangle慢性疾病分层管理模型和分级护理制度为理论依据，查阅国内外文献，根据《中国2型糖尿病防治指南》、《中国成人2型糖尿病HbA1c控制目标的专家共识》、《中国成人2型糖尿病患者动脉粥样硬化性脑心血管疾病分级预防指南》、《中国成人糖尿病肾脏病临床诊断的专家共识》、《中国糖尿病足诊治指南》、《我国糖尿病视网膜病变临床诊疗指南》、《2017ADA立场声明：糖尿病神经病变》和四川大学华西医院糖尿病诊治中心的医疗及护理专家意见撰写流程初稿，并制定专家函询问卷，对全国10个市、15家三级甲等医院28名糖尿病临床治疗、教育管理、教育培训、专科护理、护理管理和社区护理的专家进行2轮专家咨询，最终确立糖尿病Triangle分层分级管理流程。结果两轮专家咨询问卷回收率分别为93.33%（28/30）、96.43%（27/28），权威程度为0.93、0.94，专家意见协调系数Kendall＇s W为0.575、0.826（P〈0.05），变异系数为0.15、0.14。经2轮咨询最终确定糖尿病分层分级管理流程共包括6个一级指标、33个二级指标。结论本研究构建的糖尿病患者Triangle分层分级管理流程规范，为非住院糖尿病患者自我管理教育与支持提供了框架。ObjectiveTo establish a standardized hierarchical classification management process of self-management education and support for non-hospitalized diabetic patients.MethodsBased on the Triangle chronic disease management model and the grading nursing care system, literature review, especially on the ＂Guide to Prevention and Treatment of Type 2 Diabetes in China ＂ , ＂Expert consensus on HbA1c control goals for adult type 2 diabetes in China＂ , ＂Guidelines for the Prevention of Atherosclerotic Cerebral and Cardiovascular Diseases in Chinese Adults with Type 2 Diabetes＂ , ＂Expert consensus on clinical diagnosis of diabetic nephropathy in Chinese adults＂ , ＂Diabetes Foot Diagnosis and Treatment Guide＂ , ＂Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China＂ , ＂Diabetic neuropathy： a position statement by the American Diabetes Association＂ , the experts from Diabetes Center of West China Hospital of Sichuan University developed the first draft. Then experts＇ opinion questionnaire was developed based on the draft. Twenty eight experts from 10 cities and 15 hospitals with background of diabetes treatment, education management, training, specialist nursing, nursing management and community care were recruited, and two rounds of expert consultation were implemented by e-mail or face-to-face. Finally the standardized process of hierarchical classification management in diabetes mellitus had been constructed.ResultsThrough 2 rounds of expert consultation, the response rates were 93.33% and 96.43%. The authority coefficients were 0.93 and 0.94, the expert opinion coordination coefficient Kendall＇s W were 0.575, 0.826 （P〈0.05）, the coefficient of variation were 0.15 and 0.14. The final standardized process consisted of 6 first-level indicators and 33 second-level indicators.ConclusionThe standard of Triangle hierarchical management process of diabetes mellitus constructed in this study has been standardized, which provides a frame work for self-management educ

关 键 词：糖尿病 分级管理 自我管理教育与支持 血糖 行为 

分 类 号：R587.1[医药卫生—内分泌]