The Effectiveness of Hospital-Based Diabetes Case Management: An Example from a Northern Taiwan Regional Hospital

醫院式糖尿病個案管理成效研究－以北台灣某區域醫院為例

張煥禎(Huan-Cheng Chang) ； 張玉坤(Yue-Cune Chang) ； 李淑美(Su-Mei Lee) ； 陳美芳(Mei-Fang Chen) ； 黃美菁(Mei-Ching Huang) ； 彭竟琳(Chin-Lin Peng) ； 顏慶雲(Ching-Yun Yan)

《The Journal of Nursing Research》 15卷4期 (2007/12) Pp. 296-309

摘要

The aim of this study was to design, implement and evaluate disease outcomes at a regional hospitalbased case management program of care for patients with type 2 diabetes. Amedical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p＜.0001), fasting glucose (p＜.01) and triglycerides (p＜.05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.

關鍵字

糖尿病 ； 醫院式個案管理 ； 區域醫院

並列摘要

The aim of this study was to design, implement and evaluate disease outcomes at a regional hospitalbased case management program of care for patients with type 2 diabetes. Amedical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p＜.0001), fasting glucose (p＜.01) and triglycerides (p＜.05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.

並列關鍵字

diabetes ； hospital-based case management ； regional hospital

參考文獻

American Diabetes Association(2003).Standards of medical care for patients with diabetes mellitus.Diabetes Care.26(1),33-50.

American Diabetes Association(2006).Third-party reimbursement for diabetes care, self-management education, and supplies.Diabetes Care.29(1),68-69.

American Diabetes Association National Institute of Diabetes and Digestive and Kidney Diseases(2004).Prevention or delay of type 2 diabetes.Diabetes Care.27(1),47-54.

Boltri, J. M.,Davis-Smith, Y. M.,Zayas, L. C.,Shellenberger, S.,Seale, J. P.,Blalock, T. W.(2006).Developing a church-based diabetes prevention program with African Americans.The Diabetes Educators.32(6),901-909.

Improving diabetes patients` medical treatment on trial of health insurance (fourth revision)