國軍醫院糖尿病患門診照護品質之探討

Abstract

台灣於1995年3月開始實施全民健康保險後，國軍醫院受到客源流失及公務預算縮減的的情況下，為了在全民健保環境下健全地營運，其經營策略與方針，必須配合健保政策予以調適，特別是攸關費用償付的相關支付政策。 本研究資料來源為全民健康保險研究資料庫，研究對象為2003年第一門診診斷碼為糖尿病者（ICD-9-CM為250.XX）或第二、三門診診斷碼為糖尿病者且處方藥物中有抗糖尿病之藥物，合計62422人，並以健保局「糖尿病醫療給付改善方案試辦計畫」十項年度必要檢查項目之完成百分比作為門診照護品質的指標，分析國軍醫院糖尿病患門診照護品質的現況，並與非國軍醫院之照護品質予以比較，提供日後國軍醫院未來制訂醫療品質相關政策之參考。 本研究主要結果如下： 1.國軍醫院糖化血紅素、血糖、血清總膽固醇、空腹血清中性脂肪、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、血清肌酸酐、血清麩胺酸丙酮酸轉胺基脢、尿液分析及眼睛檢查完成百分比分別為54.1％、89.5％、60.6％、59.9％、39.6％、34.3％、62.8％、61.3％、5.9％及5.2％。 2.在控制主要就醫醫院特質及病患特質後，國軍醫院糖尿病患門診照護品質不如其他公立及財團法人醫院，但優於私立醫院。 本研究之建議如下： 1.建議國軍醫院成立糖尿病照護團隊，積極參與「全民健康保險糖尿病醫療給付改善方案試辦計畫」。 2.建置糖尿病患完整管理系統，作為資料建檔、追蹤及監控之工具。 3.簡便各項檢查的流程以及透過衛生教育的方式提高病患定期檢查的意願。 4.加強對糖尿病患糖化血色素、血糖、高密度脂蛋白膽固醇、尿液分析及眼睛檢查等五項檢查之監控。

After National Health Insurance（NHI） implemented in March, 1995，military hospitals face customer lose and the tight of defense budget. In order to operate solidly, the business strategy and operation direction of military hospitals must adjust for health insurance policies related to payment system especially. The samples selected from National Health Insurance Research Database of claimed data during 2003.The diabetic patients in this study were defined as patients whose principal diagnosis were ICD-9-CM 250.XX or sub-diagnosis were ICD-9-CM 250.XX and prescription drugs including antidiabetic drugs in 2003.There were 62422 who were eligible for study inclusion criteria.The indicator of quality of care for diabetic patients was measured by counting the percentage of diabetic patient who had completed 10 laboratory examinations of Share Care Disease Management Program for the Diabetes.The aim of this study were to understand the quality of care for patients with diabetes of military hospitals,compare with non-military hospitals and provide military hospitals with suggestions when making medical quality policy. The main findings of the study were concluded as below： 1.The percentage of diabetic patient who had completed 10 laboratory examinations were 54.1％, 89.5％, 60.6％, 59.9％, 39.6％, 34.3％, 62.8％, 61.3％, 5.9％, 5.2％ respectively. 2.After controlling hospital’ and patients' characteristics, the quality of care for patients with diabetes of military hospitals were worse then public and non-for-profit hospitals, but better than private hospitals. Based on the results of this study, a few suggestions were proposed as the following: 1.It is to establish diabetics caring team and participate Share Care Disease Management Program for the Diabetes actively. 2.It is to set up management system to collect, follow up, and monitor data for diabetic patients. 3.It is to increase patients’ will to take examinations regularly by simplifying process of each laboratory examinations and provide health education. 4.It is to monitor HbA1C, plasma glucose, HDL, Urinalysis, and eye examination densely.