The Trend Analysis of Medical Care for Type 2 Diabetes Mellitus Patients Based on Pay-for-performance Program: A Case Study of a Regional Teaching Hospital

• Main Authors: Hui-Ping Lin, 林慧萍
• Other Authors: Hung-Hui Li
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/7qkcf5

碩士 === 元智大學 === 管理碩士在職專班 === 103 === OBJECTIVES: “The Diabetes Medical Benefit Improvement Project” 'was established for more 10+ years by the National Health Insurance Administration. The patient number and care rate of Diabetic mellitus (DM) in Taiwan still increased every year. The purpose of this study was to explore the impacts on disease control, medical utilization, and effect of medical care that the DM patients of the case-hospital, joined “The Diabetes Medical Benefit Improvement Project” and transferred into the quality payment for 10+ years, were cared continuously by medical staffs. METHODS: By a longitudinal-retrospective design from 2011 to 2013, the 3025 DM patient whose major code was 250.XX, exclude type I (250.X1 &; 250.X3), and continuously visited outpatient department in the regional teaching hospital of northern Taiwan for 3 years with complete laboratory data were defined as analytic population. There were 2213 patients in the case-control group, the other 812 patients were defined as observation group. After descriptive, different and inferential statistic for the gender, age, laboratory items, comorbidity, complications and medical utilizations, the impacts of medical utilization and disease control were explored by joined the continuous medical care program or not. RESULTS: The number of female patient was 1525 which were more than the number of male patient was 1500. The majority of age distribution was 40-64 years old account for 55.64%. The second majority of age distribution was more than 65 years old and account for 39.77%. In the effect of medical care, the abnormal rates of 8 laboratory items among the total 10 items was lower for the continuous 3 years medical care group than the without care group. As part of medical utilization, the number of visit and the total fee of annual-average in the outpatient department were higher in the continuous 3 years medical care group, but the number of visit in the emergency department and admission numbers were lower than these of the without care group, relatively. The results of correlations analysis show that gender, age and the number of outpatient department visit were significantly associated with the total fee of the outpatient department. CONCLUSIONS: The results of this study revealed that the DM patients joined “The Diabetes Medical Benefit Improvement Project” had more stable variation of the annual change in the laboratory data, comorbidity, complication, and medical utilization than who didn’t join. The data in the observation group didn’t exhibit the same results, so that the impact could not fully explained by the influence of medical care team. It suggest to create a further study from the analysis of characteristics of the DM patients.