Studies of Differential Disease ManagementCare-Model ─ With Diabetes And Goutas Example

• Main Authors: Ruei-Ching Chang, 張瑞卿
• Other Authors: 邱亨嘉
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/10465566732492358818

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 94 === Abstract Introduction：Mountain township and Penghu region used integrated medical resource method for Differential Disease Management Care Model (DDMCM). This research set high incident disease like diabetes and the prevalence of gout in mountain township and Penghu region as example. The purpose of this study is to explore the variation under DDMCM program before and after medical treatment for the same disease. This study also compares the difference after DDMCM, re-visit rate, medical care and medical utilization. Method：This study is based on community medical group from Ping Tong’s three mountain township and Penghu region . Diabetes and Gout cases that had been under medical care at least one full year from January to December, 2005 were eligible as data base, and divided into two categories as medical care and medical utilization. The GEE (Generalized Estimating Equations) model was employed to analyze improvements under medical care. Diabetes clinic index are Body Mass Index、Hemoglobin A1C、systolic pressure、diastolic pressure、LDL-Cholesterol、HDL-Cholesterol. Gout clinic index are Serum uric acid、Serum creatinine and how many times gout occurred within three month. This study also analyzed one year before and after medical utilization. Result：1. Under joined care mode from mountain region counties：subsequent consultation ratio for diabetes patients are, on average, 79.23%、gout patients 91.44%；medical care have great impact on diabetes patient in systolic pressure (P=0.003) and Body Mass Index (P=0.034). gout cases are Serum uric acid (P=0.000)；after Disease Management Care-Mode. intervene medical utilization there are significant increases for total medical expense、 medical treatment attendance and clinic fee (P=0.000). 2. Penghu region under case manager mode：subsequent consultation ratio for diabetes patients are, on average, 47.10%、gout patients 48.34%；medical care have great impact on diabetes patients in Hemoglobin A1C (P=0.037) 、systolic pressure (P=0.000)、diastolic pressure(P=0.002) and Body Mass Index (P=0.018). gout cases are Serum uric acid (P=0.000)；after Disease Management Care-Mode intervene medical utilization there are significant increases for total medical expense、 medical treatment attendance and clinic fee (P=0.000). 3. The comparison for Differential Disease Management Care-Mode：mountain region counties have higher subsequent consultation ratio；mountain region counties compare to Penghu region have the following higher efficiency categories, diabetes cases are diastolic pressure and Body Mass Index、gout cases are Serum creatintine and how many times gout occurred within three month.；Penghu region compare to mountain region counties have the following higher efficiency categories, diabetes cases are Hemoglobin A1C and LDL-Cholesterol. Conclusion：Re-visit rates are higher in mountain township than the other；under DDMCM the medical care efficiency are different. For the long-term observation, these improvements for the diabetes and the gout will increase. Clinic medical utilization eminently increased after DDMCM intervention. Mountain region joined disease DDMCM with local health station had higher re-visit rates and it is recommended. Penghu region case manager mode should consider the limit of its man power. Perhaps case manager should work with local health station to increase medical staff. Joined diseases Management Care-Mode can be introduced and applied to the prevalence of disease area. Key word：Disease Management、Diabetes、Gout、Care Effect、Medical Utilization