| Summary: | 碩士 === 亞洲大學 === 健康管理研究所 === 96 === Purpose
RE-AIM Model is used in multiple-dimensionally and systematically evaluated Diabetes Shared Care Program and the executive effect of this program in Changhua County. The result of this program is the reference information of Diabetes disease of the management, related research, the approach of improvement and, the approach to evaluate this program.
Method
The date of this study was gained from the database of 4,772 patients who had participated National Health Insurance Diabetes Mellitus Disease Management Program within Diabetes Shared Care Program in Changhua County during 2005 to 2006. Description Statistical Analysis was lead in the study of the difference in each of the dimensions of RE-AIM between kinds of medical organization. The effective factors of the Hemoglobin A1C of each diabetes case who be take care one year and Diabetes Shared Care Program be offered by Changhua Community Health Center were analyzed by logistic regression.
Result
1. Reach: the percent of diabetes diseases who take medical treatment in clinic were lower among all kinds of medical organizations.（2005：11.4％，2006：13.6％）。
2. Effectiveness: In this study, Hospital account for 22.26% ( year of 2005 ) and 27.93%( year of 2006 ) in the Hemoglobin A1C poor control group（HbA1c≧9.5％）. Thus, basic clinics regard as the center Shared Care Service had the advantage in medical accessibility and reliable care.
3. Adoption: clinics’ participant percent in this program among all kinds of medical organizations is the last（2005: 4.2%, 2006:4.6%）, hospital just fewer less than Community Health Center.
4. Implementation: accountability have six indicators, but most of hospitals only perform three of six. The last three accomplishment indicators among six are kidney pathological inspection, eyes and foot exam.
5. Maintenance: Community Health Center possesses the highest percentage of patient maintenance. Hospital possesses the highest percentage of organization maintenance.
6. By analyzing Diabetes Mellitus Disease Management Program in Changhua County with RA-AIM Model, it can be found out that the care of Management Program is more efficient for diabetes patients. However, the participant percentage about hospital and clinic is low. It results that the percentage of diabetes patients is low and Population-wide Impact decreases.
7. By analyzing individual characteristic, other intervention factors and Hemoglobin A1C controlling of the program, which is entitled National Health Insurance Diabetes Mellitus Disease Management Program in Changhua County, with analysis of logistic regression, it indicated that age is positively relative to control of Hemoglobin A1C. The accomplishment ratio of exams in accountability and control.The accomplishment ratio of exams in accountability and control of Hemoglobin A1C have no relativity.
Suggestion
1. It has certain result regarding diabetic patients of Diabetes Mellitus Disease Management Program, but because the hospital and the clinic participation rate is not well, causes the covering rate of target group is not good, the overall benefit drops. Therefore the most important diligently goal in future is strengthen healing institute's participation rate to enhance the covering rate of target group.
2. The information management system is the main tool supporting quality monitoring, to build a perfect and the simple information system easily to using and inquiry, only then promotes the quality monitor and the management benefit.
3. Analyze the healthy policy using the RE-AIM construction to carry out the effect of execution and human resources influential clearly, therefore maybe can promote the RE-AIM construction in use.
|
|---|
