糖尿病临床惰性问题及其系统化预防方法

Clinical Inertia in Type 2 Diabetes Treatment and Its Systematic Prevention Approach

临床惰性(即发现问题未能及时采取治疗措施)是导致糖尿病患者长期血糖控制不达标的主要原因,并可带来严重的并发症,在国外受到研究者的广泛关注,而我国作为糖尿病人数最多的国家却鲜有研究报道。本文系统梳理临床惰性的定义、测量方法,剖析其产生原因及干预措施,并聚焦当前研究薄弱问题,最终提出基于医疗失效模式与效应分析(HFMEA)确定临床惰性的关键失效模式,应用因果分析法找到失效的根本原因及其作用机制;然后针对性地提出干预措施,优化治疗流程,形成预防临床惰性的规范化操作标准;通过对糖尿病治疗过程进行连续性监控,追踪分析失效指标,从而防止治疗延迟发生,纠正不良结果,降低临床惰性发生风险。

Clinical inertia,defined as the failure to initiate or intensify therapy in a timely manner according to established treatment recommendations,is a key reason for the long-term uncontrolled hyperglycaemia in patients with type 2 diabetes which could subsequently lead to serious complications.It has received extensive attention from researchers abroad,yet very little research has addressed clinical inertia in China which is now home to the most diabetics worldwide.This paper systematically reviewed the definition and measurement methods of clinical inertia,and analyzed its causes and intervention measures.Focusing on the current research weakness,this paper finally proposed to determine the key failure mode of clinical inertia based on the healthcare failure mode and effects analysi(s HFMEA).The causal analysis method was used to find out the root cause of key failures and its mechanism,and then corresponding intervention measures were put forward to optimize the treatment process and form the standardized operation procedure to prevent clinical inertia.By continuously monitoring the diabetes treatment process,and tracking and analyzing failure indicators,thereby treatment delay could be prevented,undesirable effect could be corrected,and the risk of clinical inertia could be reduced.