花蓮縣糖尿病照護品質病患成果評估及其預測因子

Patient Outcomes and Their Predictive Factors of Diabetes Care in Hualien

本研究應用Donabedian(1980,1982,1985)的結構、過程、結果之架構，評估花蓮縣糖尿病照護品質，並探討病患特性及組織性因素對糖尿病照護相關病患的結果之貢獻。研究樣本採自曾在花蓮某醫院就醫者，其診斷中有糖尿病的病患名冊中隨機取樣，取得有效樣本共140名。資料收集的方式分問卷訪談和病歷查閱。資料以逐步迴歸方式檢測預測變項對糖尿病病患相關照護的三個結果變項之貢獻。三個結果變項：包括：血糖的控制、自我照顧的堅持度以及生活品質。預測的變項包括：病患性別、年齡、族群、職業、診斷時間長短、糖尿病治療方式和合併症、相關組織的結構因素（即機構的特性和醫師的專科）及照護過程（即醫病關係、組織性統合、預防性檢查及糖尿病衛教）。研究結果呈現平均糖化血色素為8.27%，糖尿病病患自我照顧行為的相關足部自我照護和自我監測血糖的分數較其他研究結果低，病患對生活品質的感受結果也和其他研究結果不同。有關糖尿病專業績效結果則顯現花蓮縣的糖尿病照護還有很大的改善空間。逐步迴歸分析結果顯示病患特性和組織性因素分別對三項糖尿病照護品質結果上有顯著差異。This cross-sectional study was aimed to measure quality of diabetes care and to explore the contributions of patients and organizational factors in patient's outcomes of diabetes care in Hualien, Taiwan. Donabedian's structure-processoutcome framework was applied to examine the outcomes and quality. One hundred and forty participants were randomly selected from the list of individuals with diabetes who were seen at a medical center in Hualien. Data collection included administering questionnaires and reviewing medical records. Patient's characteristics (gender, age, education, ethnicity, occupation, length of time since diagnosis, pattern of diabetes treatment, and comorbidity) and organizational factors in terms of structure (institute characteristics and physician specialty) and the care process (patient-physician relationships, organizational collaboration, and preventive monitoring and diabetes education) were examined in light of their contributions to patient's outcomes: glycemic control, adherence to self-care regimen, and quality of care. Findings included: three patient's outcomes of diabetes care, diabetes professional performance, and contributions of patient's and organizational factors to the outcomes. The average A1C level was 8.27%; patient's adherence to self-care regimen was moderate. Scores of patient's perception of life quality were lower in physical and psychological domains but higher in social relations and environmental domains than scores in other studies. Data about professional performance showed a need to improve preventive care for patients. Regression procedures highlighted the contributions of patient's and organizational factors to patient outcomes. The structure of care (institute characteristics, and physician specialty) accounted for 8.1% of the variation in glycemic control. Patient characteristics (levels of education and ethnicity) and organizational factors (structure and process, health institute characteristics and patient-rofessional relationships) accounted for 23.0% of the variance in adherence to self-care. Patient characteristics (patient ethnicity and comorbidity) and interpersonal processes of care (patient-professional relationships) accounted for 31.1% of the variance in perceptions of quality of life.