| Summary: | 碩士 === 國立中正大學 === 企業管理所 === 97 === The purpose of this study is to compare the quality of diabetes care administered to outpatients at the department of metabolism-endocrinology (i.e., by specialists) and other departments in division of internal medicine (i.e., by non-specialists). This present study is a retrospective design that included review of medical records and evaluation the quality of predetermined process-of-care and outcome-of-care criteria. A total of 2,874 diabetic patients treated at a regional teaching hospital in southern Taiwan were enrolled between January 2007 and October 2008. Of these, 2076 patients were treated by specialists and 771, by non-specialists.
For all qualitative measures of process, statistically significant differences were obtained between care administered by specialists and by non-specialists. The parameters used to evaluate process were frequencies of A1C test, urine test, eye examination, and of insulin injection. The values of the parameters were improved in the case of patients treated by specialists than those treated by non-specialists. Other parameters that were measured included serum triglyceride (TG) level; average risk for CHD; serum ALT (GPT) level; serum creatinine level; cholesterol profiles; HbA1C level; and degrees of A1C > 9, A1C < 7, and LDL < 100. Treatment by specialists resulted in obvious improvement in the average risk for CHD, HbA1C level, and total cholesterol level, while treatment by non-specialists helped reduce the serum ALT (GPT) level, and HBA1C level. The differences in the values of all the parameters used for the assessment of quality of care between the 2 treatment groups were not statistically significant. Patients treated by specialists demonstrated improvement in the degree of LDL < 100, while those treated by non-specialists demonstrated an improvement in degree of A1C < 7.
The findings of this review highlight the importance of developing integrated care systems involving both metabolism and endocrinology specialists and internal medicine physicians such that the public health bureau and hospitals can offer better quality of diabetes care to patients.
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