Analysis of Tuberculosis Case Management Models in Hospitals

• Main Authors: Wang-Ping Lee, 李婉萍
• Other Authors: Mei-Ling Sheu
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/93103427949270651323

碩士 === 臺北醫學大學 === 醫務管理學系 === 94 === The Bureau of National Health Insurance (BNHI) implemented the pay-for-quality demonstration program in November 2001, targeting tuberculosis, breast cancer, cervical cancer, asthma, and diabetes. The aim of the program is to encourage health care organizations to adopt the strategy of disease management by assembling healthcare teams as to to improve the medical care outcomes of patients with the aforementioned chronic diseases. And the key successful factor of disease management is to establish a case management model. The purposes of this study were to investigate the current state of tuberculosis patient management in Taiwan’s hospitals, and identify components of tuberculosis case management models. Furthermore, the impact of hospital characteristics on the inclusion of various tuberculosis case management model components was analyzed. Using the 2001-2004 hospital accreditation data, the study population comprised 492 district hospitals or above in Taiwan, after excluding those hospitals that were no longer in operation. People who were in charge of tuberculosis patient management in those hospitals were explicitly asked to respond to the survey. In early March 2006, self-administered questionnaires were mailed out to those identified hospitals. Two rounds of follow-up mailings were carried out. In the end, there were 388 questionnaires returned by late May, representing a 78.9% response rate. Among those questionnaires, there were 244 hospitals (62.9%) engaging in treating tuberculosis patients; however, four of them declined to participated in this survey further. As such, the final effective sample size was 240. Chi-squared test and logistic regression analysis were conducted to examine the impact of hospital characteristics on the adoption of tuberculosis case management models. The results showed that sample hospitals’ tuberculosis case management model components could be classified as: manpower allocation, admission management, data buildup, treatment management, nursing instruction, revisit management, and referral management. Inferential statistics results were as follows. (1). Manpower allocation – Hospital level was significantly related to if sample hospitals would employ full-time tuberculosis case managers (χ2 = 69.1, p < 0.001). Medical centers were more likely to designate full-time tuberculosis case managers. On the other hand, district hospitals tended to appoint part-time tuberculosis case managers instead. Moreover, the likelihood of those hospitals that enrolled in the tuberculosis pay-for-quality demonstration program appointing full-time tuberculosis case managers was as high as four times that of non-enrolled hospitals (OR = 4.29, p < 0.001). (2). Admission management - Hospital level was also significantly related to if sample hospitals would prescribe rules regarding admitting tuberculosis patients (χ2 = 19.9, p < 0.001). Medical centers were less likely to lay down such kind of rules, compared to their counterparts. (3). Data buildup - Hospital level was significantly related to methods of data buildup of sample hospitals as well (χ2 = 23.8, p < 0.001). District hospitals tended to use the tuberculosis patient database management system provided by the Center for Disease Control (CDC) of Taiwan, rather than design their own systems, compared to their counterparts. In addition, compared to non-enrolled hospitals, hospitals that enrolled in the tuberculosis pay-for-quality demonstration program were more likely to design their own tuberculosis patient database management systems, along with using the existing system of the CDC (OR = 2.49, p < 0.01). (4). Treatment management - The results showed that the possibility of if sample hospitals would create an ad hoc committee to be responsible for treating tuberculosis patients differed significantly by hospital level (χ2 = 52.3, p < 0.001). District hospitals were less likely to establish such a committee, among all. Furthermore, hospitals that enrolled in the tuberculosis pay-for-quality demonstration program were more likely to create such a committee, compared to their counterparts (OR = 3.82, p < 0.001). (5). Nursing instruction – The results revealed that hospital level was not significantly related to if sample hospitals would designate tuberculosis case managers in charge of related nursing instruction. However, hospitals that enrolled in the tuberculosis pay-for-quality demonstration program were more likely to set up specific nursing instruction places for tuberculosis patients than non-enrolled hospitals (OR＝4.04, p < 0.001). (6). Revisit management - Hospital level was significantly related to if sample hospitals would actively arrange revisits for their tuberculosis patients (χ2 = 14.2, p < 0.001). District hospitals were more likely to have revisit management, compared to their counterparts. (7). Referral management – Finally, hospital level was significantly related to if sample hospitals would carry out referral management for their tuberculosis patients as well (χ2 = 14.4, p = 0.001). Among all levels of hospitals, district hospitals were most likely to notify those responsible community public nurses when their tuberculosis patients were discharged. In conclusion, this study demonstrated that hospital characteristics did exert impact on the inclusion of various tuberculosis case management model components by hospitals. According to research findings, the following policy recommendations were proposed: (1). The government should systematically develop tuberculosis management manpower. (2). Hospital accreditation items should include manpower allocation with respect to tuberculosis case management. (3). The government should establish a comprehensive medical care network for treating tuberculosis patients. (4). The government should promote tuberculosis case management models aggressively. (5). Various tuberculosis patient database management systems need to be integrated to increase the accessibility for users. (6). The role played by community public health nurses should be enhanced regarding treating tuberculosis patients.