糖尿病醫療照護品質指標不同醫療機構之效益分析

The Effectiveness Analysis of Diabetes Healthcare Quality Indicators in Different Medical Institutions

目的：糖尿病位居國人前五大死因之一，提升台灣糖尿病患的照護品質以降低死亡率是醫療機構的共同目標。本研究以衛生福利部公開的糖尿病品質指標數據進行統計分析、探討糖尿病人相關檢查完成率與醫院特質之關係，以及不同特質醫療層級之糖尿病人相關檢查完成率之差異，以期能找出影響醫療照護品質的關鍵要素。方法：本研究選定2018-2020年期間，醫學中心、區域醫院、地區教學醫院三年共計369家完整上傳至衛生福利部公開網頁上的糖尿病品質照護指標之數據，以Excel做資料前處理，再匯入SPSS 26.0進行統計分析。結果：研究結果顯示，三年間的研究對象以區域醫院層級的家數的佔比最高，分別為67%；64%；及64%，但以醫院層級互相比較，相關檢查的執行率相差不大，多數民眾在執行糖尿病各項檢查的時候，雖沒有特別偏好於特定的層級醫院，但機構所屬區域別卻有顯著差異；在品質指標中，相關檢查的執行率比全國指標值低，且屬仍可改善的指標中，以「血中糖化血紅素或白蛋白指標」與目標值比較之比例最高（44.8%），其中2019年「區域別」的統計顯示，在「台北」地區的醫院執行率顯著高於其他地區（P < 0.001）。此外，「眼底檢查或眼底彩色攝影指標」與目標值比較之統計，「區域別」在2018~2020年的三年均有達到統計上的顯著差異；「東區」的各項檢查執行率則普遍低於其他地區。在用藥品質的指標上，醫學中心呈現較好的品質結果，降血糖藥物用藥重疊率較低，呈現優良的比例最高，2019年「醫院層級」與「用藥重疊率」的統計達顯著差異（P = 0.01）。結論：綜觀上述結果，本研究建議衛生主管機關可以強化並監控非醫學中心級醫療機構的用藥重疊率指標，以提升糖尿病照護的用藥品質；同時建議可評估是否提升各項糖尿病相關檢查執行率的誘因，以提升「東區」醫療機構的執行率。

Aim: Diabetes ranks among the top five causes of death in Taiwan. Improving the quality of care for people with Diabetics in Taiwan to reduce mortality is a common goal of medical institutions. This study uses the data of Diabetes quality indicators published by the Ministry of Health and Welfare to do statistical analysis and explores the relationship between the completion rate of Diabetes-related examinations and hospital characteristics, and the differences in the completion rates in different levels of medical institutes. Methods: This study uses the data of the Ministry of Health and Welfare to conduct statistical analysis and explore the critical influencing factors of Diabetes healthcare quality indicators published by hospitals on the National Health Insurance (NHI) quality indicators public website, in order to find out the key factors that affect the Diabetes healthcare quality. In this study, during the three-year period from 2018 to 2020, a total of 369 medical centers, regional hospitals, and district teaching hospitals have completely uploaded the statistical data on Diabetes medical quality care indicators to the public website of the Ministry of Health and Welfare. The data was pre-processed with Excel and then input to SPSS 26.0 for statistical analysis. Results: The study results showed that the number of regional hospitals participating each year accounted for the highest proportion of the research objects. Respectively 2018 (67.2%); 2019 (64.0%); 2020 (64.0%). Among the quality indicators, the implementation rate of relevant inspections is lower than the national indicator value, which is one of the indicators that can still be improved. In 2020, the blood testing implement ratio of “HbA1c or Albumin” has the highest improvement rate (44.8%). Among them, the “regional” statistics in 2019 showed that the hospital implementation rate in the “Taipei” region was significantly higher than in other areas (P<0.001); also, statistics on the comparison implementation rate of “fundoscopy or fundus color photography index” with the target value, the “regional” statistics have achieved statistically significant differences in the three years from 2018 to 2020; the “eastern regional” has a generally lower implementation rate of various inspections than other areas. In terms of drug quality indicators, the medical center showed better results, the overlap rate of hypoglycemic drugs was low, and the proportion of drug treatment quality was the highest. And in 2019, the statistics of “hospital-level” and “overlapping rate of medication” were significantly different (P=0.01). Conclusion: Based on our results, we suggested that the competent health authority can strengthen and monitor the drug overlap rate index of non-medical center-level medical institutions to improve the quality of medication for Diabetes care; at the same time, it is suggested to evaluate whether the incentives for improving the implementation rate of various Diabetes-related examinations, so as to increase the implementation rate of hospitals in the “Eastern District”.