病歷回溯法比較重症病人不同血糖控制法血糖控制之成效－－以某醫學中心加護病房為例

The Effectiveness of Glycemic Control with Different Methods in Critically Ill Patients-Retrospective Study: Experience of a Medical Center in the Intensive Care Unit

「全民健康保險糖尿病醫療給付改善方案」，是以醫療團隊照護模式為基礎的糖尿病疾病管理。本院糖尿病共同照護網新收案率自2005年12.88％降至2009年4.69％。本專案目的為提昇糖尿病共同照護網照護率，故成立專案小組，經問卷調查、探討成員討論增加醫師照護率、增加符合糖尿病共同照護網認證資格之醫師人數、修訂收案標準作業流程、護理人員跨科培訓糖尿病衛教師、增設電腦提示系統、增加糖尿病衛教門診診次、簡化代碼、增設糖尿病衛教門診位置指引牌、制定衛教宣傳單張改善措施，實施八個月後照護率提昇為17.67％。此專案可為其他未加入或已加入「全民健康保險糖尿病醫療給付改善方案」醫療院所規劃與管理時之參考。

The 'Pay-for-Performance Program for Diabetes under National Health Insurance' is a strategy for diabetes disease management that employs a team-based care model. The patient enrollment rate in the diabetes shared care network of the study hospital decreased from 12.88% in 2005 to 4.69% in 2009. The purpose of this project was to improve the care rate in the diabetes shared care network. The project team undertook a questionnaire survey and an in-depth discussion was conducted; strategies were then determined, including increasing the number of certifi ed physicians in the diabetes shared care network, revising the standard operating procedures for enrollment, cross-training nurses to be diabetes educators, establishing a computer alert system, adding outpatient diabetes education services, simplifying code selection, setting up direction sign boards for outpatient diabetes education clinics, and designing health education pamphlets on improvement strategies. After an 8-month intervention, the patient care rate increased to 17.67%. This project could serve as a reference for administrators in other medical institutions that have or have not implement the' Pay-for-Performance Program for Diabetes under National Health Insurance.'