| Objective A retrospective analysis based on real world data was conducted to explore how chronic disease management efforts affect health outcomes associated with stroke in patients with diabetes,and to provide an evidence-based basis for improving diabetes-related chronic disease management.Methods Firstly,based on the BCW theory,this study analyzed the chronic disease management for a retrospective analysis.And this study used real world data real world data in Jiading District of Shanghai from 2017 to 2020.Secondly,the PICOS analysis framework was used for empirical analysis.The research object(P)in this study was all diabetics in the real data of chronic disease management and diagnosis and treatment of patients in Jiading District;Shanghai from 2017 to 2020.The comparison between the chronic disease management group(I)and the control group(C)in this study included the comparison between the subjects who received the chronic disease management work and those who did not accept the chronic disease management work,the comparison between the health status and the incidence of stroke of the subjects who accepted different chronic disease management work;also the study outcome(O)was the effect of chronic disease management on the health outcomes of diabetic patients with stroke;the design of this study(S)was to explore which chronic disease management work is more conducive to the prevention of stroke disease of patients with diabetes mellitus and put forward reasonable reform suggestions for optimizing the chronic disease management work.Again,data were processed using Stata17.0 software,and statistical descriptive and univariate analyses were performed using t-tests and chi-square tests for the 45,777 cases included in the study with respect to demographic characteristics such as age,gender,education,family history of diabetes,clinical symptoms,and payment patterns,clinical indicators,and economic characteristics.Finally,Logit multiple regression model was used to analyze the impact of chronic disease management efforts on the health outcomes of patients with diabetes mellitus complicated by stroke.Results Logit model empirical analysis showed that: First,the overall health outcomes of follow-up efforts and stroke were negatively correlated(P<0.001),indicating that diabetic patients receiving follow-up work were less likely to have stroke.Of these,677(3.33percent)diabetic patients who were followed up face-to-face in the community had stroke,and 464(3.26percent)diabetic patients who were not followed up in the community had stroke.There was no significant difference in the satisfaction with different follow-up methods.The satisfaction of patients was higher than that of unsatisfied patients,but the satisfaction was less than 80%.Second,there was a negative correlation between exercise intervention and the overall health outcomes of stroke(P<0.001),indicating that diabetic patients receiving exercise intervention were less likely to have stroke.Of the 23364 patients who received exercise intervention,most had mild and moderate exercise.Mild exercise was performed in 18669 patients with an average activity frequency of3.02 ± 1.18(times per week)and an average activity duration of 3.88 ± 1.78(times per minute),of which 603 patients with diabetes and stroke accounted for3.25%.Moderate exercise was performed in 4729 patients with an average activity frequency of 3.15 ± 1.09(times per week)and an average activity duration of4.53 ± 1.82(times per minute),of which 158 patients with diabetes had a stroke rate of 3.36%.Third,there was a negative correlation between diet control and stroke health outcomes(P<0.001),indicating that diabetic patients with diet control were less likely to have stroke.Of the patients on diet control,23482(84.03%)had good compliance and 0.03% had stroke;4462(15.97%)had poor compliance and 0.04% had stroke.Fourth,there was a negative correlation between drug intervention and the overall health outcomes of patients with stroke(P<0.001),indicating that diabetic patients with drug intervention were less likely to have stroke.Among 28387 patients,81 patients(0.29%)had adverse effects after drug intervention and 0.04% had concurrent strokes;28306 patients(99.71%)had no adverse effects after drug intervention and 0.01% had concurrent strokes.Fifth,there was a negative correlation between health education and the overall health outcomes of stroke(P<0.001),indicating that diabetic patients with health education were less likely to have stroke.Most of the 32806 patients received one or two forms of health education,accounting for 79.43%and 14.61% respectively.Among them,83.23% of the patients receiving one form of health education had good psychological adjustment ability,and 825 patients(0.03%)had stroke-related diseases;86.61% of the patients receiving two forms of health education had good psychological adjustment ability,and 177 patients(0.04%)had stroke-related diseases.The results showed that there was little difference in stroke among diabetic patients receiving 1 or 2 forms of health education.Conclusion Chronic disease management can affect the health outcome of diabetic patients with stroke.Community follow-up,exercise intervention,diet control,drug intervention and health education-related chronic disease management work,the health level of diabetic patients improved,more difficult to complicated stroke.At present,there are some problems in the management of diabetes related chronic diseases,such as low satisfaction of follow-up,lack of pertinence of exercise intervention,poor compliance of diet intervention,adverse reactions caused by taking multiple drugs,and single form of health education.Suggestions In view of the above problems,the following policy recommendations are put forward: online and offline follow-up visits shall be conducted to improve the satisfaction of patients with follow-up visits;targeted exercise intervention shall be conducted based on the actual situation of patients;correct dietary concepts shall be established to form good compliance behaviors;rational drug use shall be made to reduce the risks that may be caused by adverse drug reactions;and diversified forms of health education shall be developed in light of individual characteristics of patients. |
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