評估糖尿病品質改善計畫之長期效益

Evaluating the long-term effectiveness of diabetes quality improvement program

目的：糖尿病為一種常見的慢性疾病，隨著現代人生活方式的改變，人口老化問題，糖尿病罹患人口有逐年增加的趨勢，台灣糖尿病人口在近十年來增加兩倍，目前已造成台灣在健康、經濟及社會的重大負擔。本研究評值糖尿病個案模式管理下對於長期追蹤之患者其三高藥費與三高之健康指標變化。方法：為縱貫性研究，收集台灣某教學地區醫院自2009年至2011年間皆持續規律回診之糖尿病健保專案就診之個案管理患者為樣本資料，探討在糖尿病個案模式管理下對於長期追蹤之患者其三高藥費與三高健康指標之變化。結果：共分析3,252人為期3年資料，分析資料顯示在三高藥品費用部份，三高藥費加總與每次就診平均三高藥費逐年遞減(p＜0.001)；在三高健康指標部份，血壓(p＜0.001)、糖化血色素(p=0.006)、總膽固醇(p＜0.001)、三酸甘油酯(p=0.003)、高密度膽固醇(p=0.031)與低密度膽固醇(p＜0.001)，其在個案管理模式下患者皆有進步的趨勢。結論：在長期糖尿病個案管理模式對於糖尿病三高藥費支出的影響及患者健康指標改善之外，及其所產生之效益所獲得的長期追蹤成果作為醫院之政策管理的參考，亦提供後續各類研究參考，提升在糖尿病長期健康管理上的認知並促進醫療資源有效使用。

Objective: Diabetes Mellitus is an endemic chronic disease that causes the major health issues. The population of diabetes has been doubling in the past two decades. It is found to be associated with aging, obesity and western lifestyle. Through its chronicity and multiple comorbidities, Diabetes mellitus is the most known social-economic burden in our healthcare system. This study is aim to evaluate the long-term effectiveness of diabetes quality improvement program by the national health insurance bureau. Methods: This is a three year longitudinal follow-up study in an teaching hospital from 2009 to 2011. Totally 3217 diabetic patients receiving regular outpatient visit and entering the diabetes quality improvement program were included in the study. Medication cost of the hyperglycemia, hypertension and hyperlipidemia and the major healthcare outcome indicators were compared. Results: The results showed that the total medication cost of the hyperglycemia, hypertension and hyperlipidemia decreased gradually and reach statistical significance (p＜0.001); there are also significant improvement in blood pressure (p＜0.001), HbA1c(p=0.006), total cholesterol (p＜0.001), triglyceride (p=0.003), HDL (p=0.031) and LDL (p＜0.001). Conclusions: The long-term effectiveness of diabetes quality improvement program raised by the national health insurance bureau has been shown to be promising. It not only reduced the costs of pill burden but also improve the major cardiovascular outcome indicators. Through these results, we urge that the Ministry of Health and Welfare should invest more resources in the raising quality care model of chronic diseases especially the Diabetes Mellitus.