運用品管圈手法降低全院門診糖尿病病人HbA1C>9%比率

Using Quality Control Circle Method to Reduce the Rate of HbA1c>9% in Outpatients with Diabetes

糖尿病是個複雜慢性病，因此健康議題受到相當重視。本院為糖尿病健康促進機構，於2020年全院門診糖尿病人糖化血色素(HbA1C)>9%的比率高達10.5%，引發專案小組改善動機。經品管手法確認真因為：1.病人對胰島素迷思拒絕施打及無病識感、2.病人對醣類知識不足及受節慶食物影響、3.外出運動受疫情限制、4.糖尿病共同照護網外病人無法定期追蹤及符合照護網資格醫師數少、5.缺乏有系統的管理工具，運用PDCA進行對策改善，包括製作多語醫病共享決策胰島素創意教材、強化醣類認知之控醣計劃、居家運動流程規劃與訓練、提升醫師認證與跨科照護與連結糖尿病遠距照護，改善結果發現全院糖尿病人HbA1C>9%比率降至8.7%，顯示此專案確實助於提升糖尿病人之照護品質。

Diabetes is a complex chronic disease, and this issue has been considered important. In 2020, the rate of glycosylated hemoglobin (HbA1C)>9% in outpatients with diabetes in our hospital was as high as 10.5%, which initiated the motivation to improve. According to quality control methods, the real reasons of the high rate were: 1. Many patients refused to inject insulin and had no awareness of the disease; 2. The patients had insufficient knowledge of carbohydrates and were caused by incontinence of food on festivals; 3. Outdoor exercise was restricted by the epidemic situation; 4.Unable to track patients regularly and many physicians lacked of the qualifications of diabetes shared care network, 5. Lack of systematic management tools. Using PDCA to improve countermeasures, including making multilingual medical and patient sharing decision-making insulin creative teaching materials, strengthen carbohydrate awareness, home exercise process planning and training, improving physician certification and interdisciplinary care. The results of the improvement found that the rate of HbA1C>9% of diabetics in our hospital dropped to 8.7%. It showed that this project really helped to improve the quality of care for diabetics.