糖尿病的門診醫療專業品質初探

A Preliminary Study on Professional Quality Assessment for Diabetes Outpatients

吳重慶(Chung-Chieng Wu) ； 葉淑娟(Shu-Chuan Jennifer Yeh) ； 顏裕庭(Ernest YT Yen) ； 黃明和(Min-Ho Huang)

《秀傳醫學雜誌》 3卷2&3期 (2002/04) Pp. 47-53

摘要

Background: The National Health Issurance has been operating for more than 6 years in Taiwan, although it now encounters 2 major problems: the difficulry on both finance and quality. While several Enterprices have been engaging in the management of the medical industry, operating efficiency became more and more important, and thus the medical service quality became: however, the medical professional quality seems overlooked or even ignored. In 1998, an island-wide survey revealed that the clinical control for diabetes (DM) outpatients was not so ideal, but nearly 50% of them had a fasting blood surgar (AC) ＞60% had a glycosated hemoglobin (HbA1C)≧7.4%. In this study, we intend to observe the real situation of medical professional quality control for DM outpatients.
Materials and Methods: 3 DM-OPDs (outpatient clinics) among the 12 hospitals, encoded as A, B and C repectively, were enrolled. Patient volumes per service section, spending about 3 to 4 hrs each, were 111.3±14.8, 65.9±16.2 and 33.6±7.2 (mean ± SD, F-test, P＞0.001) respectively, during 1998 and 1999. Sampling: Those patients, aged≧62 yr-old and visiting the above 3 OPDs during the 1st 3 week-days of the 2nd week in March 2000, but receiving DM control continuously for ≧ 6 ms during 1998 and 1999, were the subjects. These included 34, 50 and 30 patients per service section for OPD A, B and C, respectively. Measurements: For evaluation of process quality, there were 9 items as frequency of OPD-visits (OPD-N), BP-measurements (BP-N), AC sugar tests (AC-N), Urine-protein tests (UR-N), serum lipid tests (chole/TG-N & HDLC/LDLC-N), creatinine tests (Cr-N), HbA1C tests (HbA1C-N) and creatinine-clearance tests (CCr-N). And, for evaluation of outcome quality, there were 8 items as measurements of BP, AC, UR, chole/TG, HDLC/LDLC, Cr, HbA1C and CCr, the abnormal rates were used for observation. X2-test was utilized for statistical analysis.
Results: P rocess quality: Patients of OPD C had an OPD-N higher than OPD A and B; for OPD-N≧1/m, there were 79%, 60% and 100% of patients in OPD A and C, respectively (P＜0.01). Also, PATIENTS OF OPD C had received a significantly higher frequency of observation than OPD A and B in BP-N, AC-N, UR-N, HDLC/LDLC-N, HbA1C, Cr-N and CCr-N (see table 2). Outcome quality: Patients of OPD C and a better result on measurements of BP, AC, UR, Chole/TG, HDLC/LDLC and HbA1C than OPD A and B (see table 3).
Conclusion: 1. We developed those items for evaluation of process and outcome quality in OPD DM-control; and 2. It seems that patient volume could be an important factor influencing both the process and the outcome quality.

關鍵字

醫療品質 ； 醫療專業品質 ； 過程品質 ； 結果品質 ； 糖尿病 ； 門診

並列摘要

Background: The National Health Issurance has been operating for more than 6 years in Taiwan, although it now encounters 2 major problems: the difficulry on both finance and quality. While several Enterprices have been engaging in the management of the medical industry, operating efficiency became more and more important, and thus the medical service quality became: however, the medical professional quality seems overlooked or even ignored. In 1998, an island-wide survey revealed that the clinical control for diabetes (DM) outpatients was not so ideal, but nearly 50% of them had a fasting blood surgar (AC) ＞60% had a glycosated hemoglobin (HbA1C)≧7.4%. In this study, we intend to observe the real situation of medical professional quality control for DM outpatients.
Materials and Methods: 3 DM-OPDs (outpatient clinics) among the 12 hospitals, encoded as A, B and C repectively, were enrolled. Patient volumes per service section, spending about 3 to 4 hrs each, were 111.3±14.8, 65.9±16.2 and 33.6±7.2 (mean ± SD, F-test, P＞0.001) respectively, during 1998 and 1999. Sampling: Those patients, aged≧62 yr-old and visiting the above 3 OPDs during the 1st 3 week-days of the 2nd week in March 2000, but receiving DM control continuously for ≧ 6 ms during 1998 and 1999, were the subjects. These included 34, 50 and 30 patients per service section for OPD A, B and C, respectively. Measurements: For evaluation of process quality, there were 9 items as frequency of OPD-visits (OPD-N), BP-measurements (BP-N), AC sugar tests (AC-N), Urine-protein tests (UR-N), serum lipid tests (chole/TG-N & HDLC/LDLC-N), creatinine tests (Cr-N), HbA1C tests (HbA1C-N) and creatinine-clearance tests (CCr-N). And, for evaluation of outcome quality, there were 8 items as measurements of BP, AC, UR, chole/TG, HDLC/LDLC, Cr, HbA1C and CCr, the abnormal rates were used for observation. X2-test was utilized for statistical analysis.
Results: P rocess quality: Patients of OPD C had an OPD-N higher than OPD A and B; for OPD-N≧1/m, there were 79%, 60% and 100% of patients in OPD A and C, respectively (P＜0.01). Also, PATIENTS OF OPD C had received a significantly higher frequency of observation than OPD A and B in BP-N, AC-N, UR-N, HDLC/LDLC-N, HbA1C, Cr-N and CCr-N (see table 2). Outcome quality: Patients of OPD C and a better result on measurements of BP, AC, UR, Chole/TG, HDLC/LDLC and HbA1C than OPD A and B (see table 3).
Conclusion: 1. We developed those items for evaluation of process and outcome quality in OPD DM-control; and 2. It seems that patient volume could be an important factor influencing both the process and the outcome quality.

並列關鍵字

healthcare quality ； medical professional quality ； process quality ； outcome quality ； diabetes mellitus ； outpatient department