糖尿病門診照護品質與就醫機構相關性探討

Investigating the Quality of Outpatient Care for Diabetic Patients in Different Health Care Organizations in Taiwan

目標：探討「全民健保糖尿病醫療給付改善試辦計畫」介入後，不同層級就醫機構之糖尿病患門診照護品質是否有差異。方法：本研究為橫斷性研究。研究對象為2003年全民健保全年度醫療利用中年度門診主、次診斷合計出現兩次（含）以上糖尿病之患者。排除取樣條件後有799,350人納入研究。利用該試辦計畫公布十項年度必要檢驗（包括：糖化血色素、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、血清肌酸肝、血清麩胺酸丙酮酸轉氨基酶、尿液分析與眼睛檢查）之執行與否，作為門診照護過程面品質的測量。結果：在控制主要就醫機構屬性及病患特質後，醫學中心病患完成十項檢驗之可能性均高於診所；與區域醫院相較則五項較高、二項較低、三項相若；與地區醫院相較為七項較高、三項相若。結論：在全民健保實施糖尿病醫療給付改善試辦計畫初期，評鑑等級愈高的機構對糖尿病患門診照護過程面品質表現愈佳，而未有評鑑機制之診所，其照護品質與各級醫院似有較大差距。

Objectives: This study investigated the differences in the quality of outpatient care for diabetic patients among different health care organizations in Taiwan, and tried to determine the factors related to these differences. Methods: A total of 799,350 patients who were eligible enrollees in Taiwan’s National Health Insurance in 2003 were studied. Ten examinations (HbA1C, glucose, total cholesterol, serum triglyceride, high-density lipoprotein, low-density lipoprotein, serum creatinine, glutamic pyruvic transaminase, urinalysis, and eye exam) required by the Quality Improvement Demonstration Program for Outpatient Diabetes Care initiated by the Bureau of National Health Insurance were used to assess the quality of outpatient care for diabetic patients. Results: Medical centers had acceptable rates for seven of these exams. Regional hospitals had acceptable rates for two exams, district hospitals for only one (glucose), and clinics had none. Conclusion: The higher the accreditation level health care organizations had, then the better quality of outpatient care they provided. It appeared that the quality of outpatient care for diabetic patients provided by clinics was not comparable to that provided by hospitals.