| Summary: | 碩士 === 中國醫藥大學 === 醫務管理研究所 === 93 === Abstract
The purposes of this study are check-up, and outcomes in patients with diabetes after participating in Diabetes Mellitus (DM) Promotion Improvement Program and to compare the differences among diabetic patients who participate and don’t participate in the program.
This study adopted Quasi-experimental design – non-randomized comparison group - pretest-posttest design. The study sample consisted of outpatients withICD-9-CM primary diagnosis code 250 from outpatient clinics of a Medical Center in Mid-Taiwan during the period from 2002 to 2004. There are 344 DM patients in study group and 1968 DM patients in control group. Type of medical care utilization included outpatient, inpatient, and emergency room use.
Our results indicates that the study group significantly decreases in medical service utilization of the outpatient visits, mean exam expenditure per outpatient visit, hospitalized utilization (number inpatient admissions, mean length of stay per visit, mean inpatient pharmacy expenditure, mean laboratory exam expenditure, and total inpatient expenditure), emergency utilization (mean emergency pharmacy expenditure per visit, exam expenditure, and total emergency expenditure), and mean inpatient co-payment per visit. However, the completion of laboratory exams increases significantly after participating the program and these items included glycated hemoglobin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, blood urea nitrogen, retina test. For the medical outcome, only triglyceride and blood urea nitrogen significantly improved.
The results regarding the effectiveness of Diabetes Mellitus Promotion Improvement Program on the use of medical resource shows that the changes in number of outpatient visits in six months and the fee per outpatient visit in the study group is significantly less than control group during study period. While the changes in mean outpatient pharmacy expenditure per visit, mean outpatient exam expenditure per visit, mean total outpatient expenditure, mean inpatient admission, mean length of sty per admission, mean laboratory exam expenditure, total inpatient expenditure, mean emergency exam expenditure per admission, the total expenditure covered by National Health Insurance, and total medical expenditure are significantly higher in control group than study group.
The results regarding the effect of Diabetes Mellitus Promotion Improvement Program on screening tests indicates that the program significantly increases the completion of HbA1c, fasting plasma glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, urine albumin, creatinine, blood urea nitrogen, and retina examine.
The results about effect of Diabetes Mellitus Promotion Improvement Program on the outcomes indicate that during the study period, there is no effect on improvement of glycated hemoglobin, fasting plasma glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, creatinine, blood urea nitrogen.
National Health Insurance is encouraging care providers to adopt Diabetes Mellitus Promotion Improvement Program in their practice. With regard to the unlimited use of medical resource, the mechanism for financial control has never been achieved. To aim at controlling increasing medical expenditure, capitation should be considered. In addition, Diabetes Mellitus Promotion Improvement Program only focuses on the adherence to the standard of care without considering the care outcome. We would recommend National Health Insurance put emphasis on care outcomes by establishing the goal for disease control in addition to standard of care to promote care outcomes.
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