The effectiveness of an integrated care model on patients with multiple chronic diseases: evaluation from a regional hospital in Southern Taiwan

• Main Authors: Mai-Fan Chang, 張梅芳
• Other Authors: Yang Tsan
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/36085446682087937961

碩士 === 美和科技大學 === 健康照護研究所 === 101 === Since the implementation of National Health Insurance, the domestic medical resources have been gradually popularized and the mortality rate has been decreased year by year, and the enhancement of access of care has made outpatient visits doubled; in the meantime, along with the aging of the population of the country, the prevalence rate of multiple chronic diseases has increased year by year, patients with multiple chronic diseases thus have become the most important resource users in health care system. The purpose of this study is mainly to understand the medical utilization situations and important factors of patients with multiple chronic diseases, and to explore and compare the differences of medical utilization effectiveness before and after the implementation of integrated care model. The data used in this study come from the Registry for Beneficiaries (ID) Claims Data Files of National Health Insurance Research Database from January 2008 to June 2009 (a total of 18 months), a list of total 4,054 loyal patients of the Hospital was provided, after screening the number of objects complying with integrated care plan is 1,935. This study adopted secondary data analysis, and took the same batch of patients divided into two stage (before implementation:2008/1~2009/6; after implementation: 2010/1~2011/6), to use paired-t, chi-square (χ2) test, independent samples t-test and one-way ANOVA and multiple regression analysis to explore the patients with multiple chronic diseases and their medical utilization situations as well as the important factors affecting changes in health care costs before and after the implementation of integrated care model. Study results: the medical utilization results before and after the implementation of integrated care model reveals that after the implementation the average number of medical visits per person per year is decreased by 4.83 visits, the average number of visited physicians per person per year is decreased by 0.09 physicians, the average number of visited medical divisions per person per year is decreased by 0.08 divisions, the average number of used medicine items per person per year is decreased by 0.83 items, and the average total medical expenses per person per year is decreased by NT$ 6,519.17. In the chronic disease category grouping, the one-way ANOVA analysis shows that, whether before or after the implementation of integrated care model, all of average numbers of chronic diseases, medical visits, visited physicians, visited medical divisions and used medicine items, as well as total amount of medical care expenses have reached a statistically significant difference (P <.001). In the age grouping, except that age has no significant influence on medical expenses after the implementation of integrated care model, for senior citizens above the age of 81 years, whether before or after the intervention of integrated care, all of health care utilization items including average number of chronic diseases, medical visits, visited physicians, visited medical divisions and used medicine items have had an obvious increasing trend along with the increase of age. From these results it can be inferred that, age is not a single principal factor which may affect the change in health care costs, the contents of effect not only cover the number of chronic diseases, but also cover the severity of different types of chronic diseases. Then this study further used multiple regression analysis, it was found that, in terms of age, before the implementation of integrated care model the total amount of health care expenses will be reduced by NT$ 85.63 for each additional 1 year of age, and after the implementation of integrated care model the total amount of health care expenses will be reduced by NT$ 177.33 for each additional 1 year of age; so, whether these results are associated with severity of diseases is worthy of further exploration in future studies. Conclusion: the concept of Holistic Health Care also can be achieved through integrating physicians’ prescriptions via medical visit process and information platform, regularly monitoring to proactively identify patients with high risk, enhancing coordinated care function of case managers, strengthening inter-profession communications and active involvement of team work, and reducing improper repeated utilization of medical resources by integrating medical professions to render patients with perfect medical care.