An Evaluation on the Performance of Diabetes Mellitus Medical Benefit Improvement Project in a Medical Center

• Main Authors: Wayne Huey-Herng Sheu (Hui-Heng Hsu), 許惠恒
• Other Authors: 楊銘欽
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/79834482381263848523

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 91 === Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance had proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive. Purpose: To investigate if implementation of Diabetes Education Improvement Program could improve glucose control, enhance screening rate of diabetic complications, increase scores of self-management, compliance behavior and family support obtained from questionnaire in diabetic subjects. Method: This study was carried out for 6 months in a medical center at central Taiwan. Diabetes individuals with newly diagnosed or whose hemoglobin A1c level above 7.0% were invited to participate this program. Those who agreed to join (named intervention care) received scheduled screening tests and comprehensive diabetes education provided by physicians, nurses educators and dieticians. Those who declined to participate (named usual care) were cared by usual medical system. Results: A total of 107 subjects in intervention group and 88 subjects in usual care group completed this study. In subjects with intervention group, fasting glucose concentrations did not change before and at end of 6 months (168.6 ±53.1 mg/dl vs. 168.1 ±50.4 mg/dl, p=0.927), nor did change of levels of hemoglobin A1c (8.0 ±1.6 % vs. 7.8 ±1.5 %, p=0.184). However, those who had poor baseline glucose control poor (HbA1c > 8.0 %) showed significant reduction of HbA1c concentrations (9.2 ±0.2 vs. 8.4 ±0.2 %, p=0.003)。 Values of fasting glucose and HbA1c were not changed in subjects with usual care. Subjects in intervention and usual care groups who received at least one screening test during study period were fasting glucose 97.2% vs. 83.0% (P<0.001); HbA1c 98.1% vs. 37.5% (P<0.001); eyes fundi 98.1% vs. 18.1% (P<0.001); feet examinations 99.0% vs. 1.1% (P<0.001), urine protein examination 97.2% vs. 42.0% (P<0.001); blood lipids examinations 88.8 vs. 22.7% (P<0.001); electrocardiography 13.1% vs. 11.4% (P=0.828). In subjects of intervention group, scores of self-management increased from 83.5±12.9 to 90.0±11.7 (P<0.001), scores of behavior compliance from 36.6±5.3 to 38.5±4.5 (P=0.006), while scores of family support showed no change. In subjects of usual care group, scores of self-management increased from 78.7 ±11.8 to 84.3 ±11.2 (P<0.001)，while there were no changes in scores of compliance behavior and family supports. In multiple regression analysis, none of changes of scores are independently associated with fasting glucose and HbA1c in intervention group. Conclusion: Diabetes Education Improvement Program implemented for 6 months in a medical center showed improvement of blood glucose control in those with poor glucose control at baseline. This program led to a significant increase in screenings of most diabetes related complications. Scores of self-management and compliance behavior increased significantly as a result of this program. Based on these findings, this research offered some suggestions on the future researches, diabetes education program and policymaking.