Long-term Dynamic Change of Diabetes Patient care-A1c testing in Taiwan

• Main Authors: Ding-Huan Lee, 李定寰
• Other Authors: 賴美淑
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/65959357685003226233

碩士 === 臺灣大學 === 預防醫學研究所 === 95 === The Diabetes clinical care performance attaches great importance to a part of the DM quality care in recently.thats including:A1c test, blood lipid test,blood preasure test,eye test,foot test, kidney disease examine and the consultation quit of smoking. A1c test is the most immediate evaluation and the most acceptive among above, and Therefore this study bases on the A1c annual testing frequency of Taiwan’s DM clinical caer guildline, Three months one time examine, to be our analysis indicator.And we aim to analyze Long-term Dynamic Change of Diabetes Patient care-A1c testing in Taiwan. Although The DM care all belong to one National Health Insurance, is ther existing difference between each branches. That shows not clearly in past. But there are some published reference point out that the DM care quality shows difference in various area, insurance, hospital, even doctor. So we want to analyze the NHI branches’ effect and the different hospitals’ effect of Taiwan DM patient’s A1c test accountability after adjuested other co-variate. Method: This study use the Taiwan DM cohort database(620,854 people, follow 5 years)as our study population. Accounting to this five year’s NHI data to collect each 2 season to divid four types by each patient(1) both season took A1c test. (2) first season took A1c test but second did not.(3) first season did not take A1c test but second did. (1) both season did not take A1c test.we use logistic regression and GLIM model to measure the effect after adjusted below.(1)demography variate:sex、age (2)medical provider:NHI branch、hospital level (3)patient characteristics: Adjusted Clinical Group case-mixed system (ACG)、DM oral drug compliance and DM drug (4)time:different year.Finally we use monte-carlo simulation method to modify long-term charged probability in Taiwan DM patient’s A1c test. Result: Taiwan DM patients’ A1c test achievement percent grow up from 28% to 55% in five years.and type 1(both season took A1c test) becom 16.65% to 22.04%. type 2(both season did not take A1c test) becom 51.96% to 43.84%.after adjusted other covariate, A1c accountability shows improvement as year’s passing.Demography dimensoion:weman’s performane beter than men,young people better than old people. Medical provider dimensoion: medical center is the optima, area hospital the next,and clinic is the worst. And Taipei branch, Kao-Ping branch and northern region are better than other three branches.Patient characteristics dimension:the ACG shows more healthier patient have better performance in A1c test.as same result in Drug and compliance. Conclusion:Although A1c test keeps growing up in Taiwan,the medical provider dimension effect still present a stable difference.our study result responses to there is a area difference in DM care qulity of before reference.On the other hand,the markov chain’s trans-probability between hospitals shows the same thing as logistic and GLIM model shows.we suggest authority should address type 2(both season did not take A1c test) to gain more benefit. Discussion: This study was impeded by NHI data can not offer personal information.so that we need to exclude many variate to analyze, ex: education、personal income、visit doctors、smoke or not、illness period and BMI. In addtion, we also put debatable drugs in NHI payment away,like aspirin. We can’t clearly defined which visit prescription is only for DM.if we calculate all. There will be over-estimate problem.Beside drugs, NHI’s ICD_9 coding as usual have some problem in ACG system.Further more, in order to solve the restriction on GLIM model in SAS 9.2 edition and logistic regression evaluation. Sample size estimate should be considered in future.