| Summary: | 碩士 === 靜宜大學 === 管理碩士在職專班 === 96 === Performance Measurement of Disease Management:A Case Study of Diabetes Care Management
ABSTRACT
“Disease management” is a management tool adopted by “managed health care” to provide “case management” care services for specific diseases that involve different care processes from traditional care. Therefore, how to measure the performance of “disease management” has become a new management issue for medical organizations. This study discusses the performance indicators of Disease management from the stakeholders’ viewpoints in order to provide a new perspective for and visions of medical care.
This study is an exploratory research with its performance indicators constructed by literature review, secondary data, and opinions from practical experts. The author analyzes data from interviews with stakeholders to organize and compare different stakeholders’ evaluation scores on the appropriateness and importance of these various indicators, and provides suggestions for medical organizations involved in diabetes care management. The results of the study are as follows:
1. The evaluation scheme that the National Health Insurance Bureau employs to measure the performance of medical organizations in diabetes disease management projects mainly emphasizes a structural indicator, followed by medical accessibility for patients and utilization ability of medical organizations. The National Health Insurance Bureau recently emphasized the notion that medical organizations and patients “both should take responsibility”, and the Bureau’s policy is to exert budget control on medical organizations by pricing differently the service quality of the medical care team’s service in order to influence the clinical process and results indirectly.
2. The measurements of total care performance in disease management projects for the case hospital are:
1) Focus on Evidence-based clinical service directions and a cooperative and coordinated care model; 2) Establish an integrated disease management information system to provide necessary feedback on care information periodically; 3) Increase the human resources in Health Education Centers significantly to educate patients about self-disease management.
3. The important stakeholders in diabetes disease management include doctors, nurses, dietitians, administrative team, patients, and the National Health Insurance Bureau (including health administration agencies). This study organized and listed 115 indicators based on the literature review and interviews of stakeholders in order to discuss the appropriateness and importance of each indicator. Regarding the evaluation scores’ appropriateness, the indicator of “having individual health education space” received the highest average score in the structural aspect; the “degree of hospital responsibility” indicator received the highest average score in the process aspect; and the “rate of patients completing follow-up” indicator received the highest average score in the results aspect. Regarding evaluation scores based on importance, the “having individual health education space” indicator again received the highest average score in the structural aspect; aside from the “degree of responsibility” indicator, the “diabetes case management care system” indicator received the highest average score in the process aspect; and the “case received rate” indicator (threshold target rate: rate of cases received by doctors ≧30%) and the “rate of completing patient follow-up” indicator received the highest average score in the results aspect.
4. The comparison of these three different viewpoints of the care performance measurement indicators (that is, the National Health Insurance Bureau, the case hospital, and the stakeholders’ viewpoints), regarding diabetes disease management, show that the stakeholders’ viewpoints have the most indicators, and case hospitals is second, and the National Health Insurance Bureau having the least indicators. There are 29 common indicators for all these three viewpoints, with 31 common indicators for both the case hospital’s viewpoint and the stakeholders’ viewpoint, and 55 indicators occurring only among stakeholders’ viewpoint.
Keywords: Disease Management; Performance Measurement; Diabetes; stakeholders
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