The Impact of Disease Management on Clinical Indicators and Medical Utilization for Long-term Tracking of Diabetes Patients

• Main Authors: CHIU,FEI-HSING, 邱妃杏
• Other Authors: CHEN, SU-CHIU
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/9w8m92

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 107 === Background: The prevalence of diabetes mellitus is increasing while its age onset is declining, and its medical expenses stay high, therefore, there exists an impact on national health and it must be paid attention. Diabetes disease management is an indispensable and important program in the clinical chronic care model. Health Promotion Administration has continued to promote the Diabetes Share Care programs and require increased care rates. National Health Insurance Administration uses payment incentives to join the Diabetes Share Care to implement policies. The Diabetes Share Care in Taiwan has been in operation for more than 18 year, however, the research literatures regarding its implemented quality and advantages and disadvantages are mostly published in the short-term and health insurance database with a lack of joining the Diabetes Share Care for long-term tracking by a single institution. It is expected to have more long-term follow-up literatures to demonstrate whether the Diabetes Share Care programs have a significant positive effect on the patients, institutions, and medical expenses. Objective: The study used the database of outpatient visits in a specific medical center to analyze whether the clinical treatment indicators and medical utilization of diabetic patients were beneficial in short and long-term tracking after the Diabetes Share Care programs. Methods: The original plan used the data from the clinical databases of the three hospitals; however, it was found that some errors in the actual databases were likely to cause an increase in missing values, which worried about the impact of the research results. Therefore, a long-term medical database of outpatients in a medical center in the North District was used for analysis. A total of 9,967 diabetic patients were included. The Excel 2013 spread sheet were used for the research tool and SAS 9.4 were performed for data management and statistical analysis. The basic characteristics of the subjects were summarized by descriptive statistics. According to the propensity score matching methods 1:1 pairing, a total of 3192 subjects from the two groups in 2018 (1096 subjects in each of the experimental and control groups) were selected for paired t-test analysis. In the 2 years of 2017-2018, a total of 4811 subjects (experimental group 3764 subjects and control group 1047 subjects) data were analyzed by independent sample t test, and the difference between the mean values of the two groups were tested. Finally, during 2009-2018 period, a total of 95 diabetes patients who joined the Diabetes Share Care programs continuously for 10-year were analyzed and discussed by using descriptive statistics. Results: One year of joining the Diabetes Share Care, the mean fasting blood glucose (mg/dl) improvement in diabetic patients reached a statistically significant difference (to join, yes (experimental group)/no: mean 129.1/132.8, p = 0.0078), the improvement in HbA1C did not reach a statistically significant difference (6.98%/6.96%, p = 0.6876), and medical utilization (NT dollars) (last outpatient declaration fee) did not reach statistically significant difference (2580.1/2801.6, p = 0.2755). For 2 years of continuously joining the Diabetes Share Care, diabetic patients got better improvement in clinical treatment indicators, the average of fasting blood glucose was statistically significant (128.3/139.6, p<0.0001), statistically significant difference of mean HbA1C were also observed (6.92%/7.39%, p<0.0001), and medical utilization was also found to be more streamlined after joining the Diabetes Share Care (1648.4/2258.5, p<0.0001). Patients who joined the program for 5 years received more qualified diabetes care, and we found fasting glucose (129.4/145.3, p<0.0001), HbA1c( Glycated Hemoglobin) (6.84/7.44%) and also LDL(low-density lipoprotein,) (81.76/92.78 mg/dl) were significantly improved (p<0.0001). As the medical indicators of diabetic patients who continuously joined the Diabetes Share Care for 10 years, the fasting glucose (133.2/145.6 mg/dl), HbA1c (6.79/7.45%) and LDL (82.15/92.25 mg/dl) were significantly reduced. Finally, two-way analysis of variance was conducted to evaluate whether the clinical treatment indicators were different due to the use of oral drugs and insulin injections for diabetic patients in 2018. It was found that patients who used oral drugs and insulin injections could achieve better results when joining the program 1 year (HbA1c: 6.69/7.0%, p<0.0001), reaching statistically significant results. Suggestion: It is important to suggest early stage of oral medication diabetic patients to join the Diabetes Share Care programs soon in benefits and advantages. The provision and involvement of health education skills also make the patient willing to participate in the Diabetes Share Care. Of course, diabetic patients joining the program by the encouragement and guidance of clinicians will also make the Diabetes Share Care successfully. Expanding to cross-disciplinary physicians to integrate chronic diseases management is an important trend in the future. It is the greatest welfare of the personal health to reduce the occurrence of co-morbidities and reduce the cost of social medical care.