Published online Jul 15, 2023. doi: 10.4239/wjd.v14.i7.1091
Peer-review started: January 10, 2023
First decision: January 31, 2023
Revised: February 20, 2023
Accepted: May 17, 2023
Article in press: May 17, 2023
Published online: July 15, 2023
Processing time: 184 Days and 1 Hours
Cardiovascular disease (CVD) is the leading cause of death globally and diabetes mellitus (DM) is a well-established risk factor. Of the fatal outcomes of CVD, acute myocardial infarction (AMI) is the most common.
DM is a major modifiable factor for CVD, and good quality of care can reduce the risk of AMI in patients with DM. Therefore, a long-term quality-of-care score for DM may predict the occurrence of AMI among patients with type 2 DM and thus guide the care.
To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM.
Using Taiwan’s Longitudinal Cohort of Diabetes Patients Database and the medical charts of a medical center, we identified incident patients diagnosed with type 2 DM. We constructed a summary quality-of-care score consists of process indicators, intermediate outcome indicators, and a hallmark co-morbidity. The associations between the score and the incidence of AMI were evaluated using Cox regression models.
A total of 7351 patients were enrolled. In comparison with participants who had scores ≤ 1, those with scores between 2 and 4 had a lower risk of developing AMI [adjusted hazard ratio (AHR) = 0.71; 95% confidence interval (95%CI): 0.55-0.90], and those with scores ≥ 5 had an even lower risk (AHR = 0.37; 95%CI: 0.21-0.66). The performance of this score in predicting the risk of AMI is better than that of a widely used scoring system.
Good quality of care can reduce the risk of AMI in patients with type 2 DM. The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.
The quality-of-care score developed in this study can be applied to guiding the care for these patients, but different healthcare systems may make modifications to the scoring system for better application.