Zhongguo quanke yixue (Feb 2024)
A Study of Root Causes and Countermeasures for Clinical Inertia in Type 2 Diabetes Patients in Community Based on Healthcare Failure Mode and Effect Analysis Framework
Abstract
Background Since 2009, community health management for type 2 diabetes mellitus (T2DM) has been significantly promoted and implemented as a national public health service program. However, the impact of clinical inertia, defined as failure to take timely interventions when therapeutic goals are unmet, hinders the achievement of long-term optimal glycemic control in T2DM patients. Therefore, addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management. Objective To identify the key failure modes of clinical inertia in community health management for T2DM, systematically analyze the underlying causes of these failure modes, and propose corresponding intervention measures. Methods Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis (HFMEA) framework, a foundational comprehension of community health management processes for T2DM, the root causes of clinical inertia, and prospective intervention measures were obtained through field research, interviews, and literature review from 2020-01-01 to 2023-06-30. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation during 2022-01-10—02-25, to delineate the key failure modes, their root causes, and intervention measures concerning clinical inertia in community health management for T2DM. Results The expert authority coefficients for the first and second rounds were 0.791 and 0.729, respectively, ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the risk priority number (RPN) metric and ranked in descending RPN value as follows: untimely insulin treatment, untimely alcohol cessation, untimely routine referral, untimely smoking cessation, untimely emergency referral, untimely triple therapy, untimely weight control, untimely dietary modification, untimely dichotomous therapy, and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients, physicians, and the healthcare system, enabling the formulation of targeted intervention measures. Conclusion The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority, providing a robust foundation for enhancing the community health management model for T2DM.
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