| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === Background: Disease Management refers to the use of an explicit systematic population-based approach to identify people at risk, intervene with specific programs of care, and measure clinical and other outcomes. Hypertension affects approximately 15~20% of adult individuals in Taiwan, The relationship between BP and risk of cardiovascular disease events is continuous, consistent, and independent of other risk factors.
Purpose: To investigate the impacts of Disease Management on clinical outcomes and costs for patients with hypertension.
Methods: This study was carried out in a community hospital in Taipei City. Individuals of hypertension were defined, according to JNC-7 definition. The intervention group received scheduled screening tests and education (JNC-7 Lifestyle modifications to manage hypertension), provided by cardiologist, nurses and dietician. The control group was given usual medical care.
Results: There were a total of 77 subjects in intervention group and 66 subjects in control group. In the intervention group, BP with well control changed from 50.65% to 62.33% after intervention. On the contrary, BP in control group with well control, changed from 63.63% to 65.15%. By comparing the results before and after intervention, the control group had more cardiac events than that the intervention group had (CHF: 6.06 % V.S. 1.30%, Hypertension crisis: 6.06% V.S. 1.30%, Hemorrhage stroke: 1.52% V.S. 0%). Comparing the outpatient costs of these two groups, although the intervention group expense was less than that of the control group in average, it was not significant statistically.
Conclusion: Disease management for hypertension outpatient clinic in a community hospital showed an improvement of blood pressure control and reduction of the cardiac events, although the expense of the patients were not different statistically in the short term follow-up. Based on these findings, this research offered some suggestions on the future researches and policy making.
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