| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 94 === Diabetes mellitus, high cost and high medical resources utilization disease, has become common chronic disease in Taiwan due to diet and lifestyle change. So Bureau of National Health Insurance implemented a Share Care Disease Management Program for the Diabetes on November 2001 to enhance quality of care. In requires diabetes, patients to adhere treatment regimens to achieve maximum regimen effect. The purpose of this study was to establish compliance indicators (including taking medicine、care guideline adherence、Physician-Patient communication ) by analyzing health insurance datasets and to investigate the relationship between compliance and outcome of diabetes care.
Datasets used in this study were from National Health Insurance of National Health Research Institute and system of Share Care Disease Management Program for the Diabetes. Dataset from November, 2001 to June, 2002 with the diagnosis code ICD-9-CM 250. There were 10,624 who were eligible for study inclusion criteria, and 54,135 who were not. Among those, who were eligible, 5,049 patients completed one and half year of follow-up.
The study results show that number of Western Medicine outpatient visits and total outpatient expenditure increases as duration for patients, Participation in program increases；and number of total outpatient visits、 length of stay, and number of inpatient decreases. For relationship between patient characteristics and care quideline adherence, type of hospital, areas for insurance, type of hospital , areas for insurance registration and type of treatment were significant factors. For relationship between medical outcome and compliance , outpatient visit increases as delay appointment rate, and eyeground and urine examination compliance is good ; length of stay decreases as delay appointment rate, decreases, and blood examination compliances is better ; total inpatient expenditure decreases as urine examination is good , number of physicians that patient visit increases, number of clinical settings that patient visit decreases, and proportion of visits at the major clinical settings decreases ; good urine examination compliance , proportion of urine by the major physicians, and of physicians are associated with the increased adds of poor glucose control.
This study indicates that after patients participating Disease Management program, medical service utilization increases, patient have better compliance and partial medical service utilization has improved, but HbA1c control is worse, suggesting that we need to to an evaluation plan to monitor effect of the Disease Management program in the future . Moreover, education behavior need to been emphasized on diabetic patients and to declared for monitor the situation of diabetic care to enhance quality of care.
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