提升「糖尿病醫療給付改善方案」眼底檢查執行率

Improve the Funduscopic Examination Rate through the Project of Pay-for-Performance Program

賴曉伶(Hsiao-Ling Lai) ； 楊昇紡(Seng-Fang Yang) ； 巴秀霞(Hsiu-Hsia Pa) ； 林美秀(Mei-Hsiu Chen) ； 廖敏娟(Min-Chuan Liao) ； 曾競鋒(Thing-Fong Tzeng)

《寶建醫護與管理雜誌》 9卷2期 (2011/12) Pp. 11-22

https://doi.org/10.29681/PCJHM.201112.0003

摘要

糖尿病視網膜病變是成年人失明最主要的原因，早期並無症狀，事先的篩檢、預防，能降低患者失明和減輕政府醫療負擔，根據健保局「糖尿病醫療給付改善方案」品質指標，眼底檢查每年需追蹤一次，依本院2008年眼底檢查執行率為11%，相較健保局2008年品質指標為63.92%，明顯偏低，故引發本專案改善動機。經調查眼底檢查執行率偏低原因為眼底檢查認知不足、當診次無法完成眼底檢查、受檢程序繁瑣。為改善上述問題，本專案採行解決辦法為加強眼底檢查相關衛教、訓練專業檢查人員，增加眼科檢查診次、協助眼底檢查排檢、簡化眼底檢查流程。方案推行後眼底檢查執行率由11%提升至65%，已達專案目的。可提供糖尿病照護團隊人員類似之問題解決參考。

關鍵字

糖尿病 ； 視網膜病變 ； 眼底檢查

並列摘要

Diabetic retinopathy is the main cause for blindness in an adult of which the early stage is asymptomatic. Screening and prevention can reduce the rate of blindness in patients and decrease the burden on government health care. According to the quality of care indicator of Pay-for-Performance Program for Diabetes under the Taiwan Bureau of National Health Insurance, the patients should perform a funduscopic exam once per year. The implementation rate of the funduscoptic examination at the case hospital was 11% in 2008, comparing with the 63.92% quality of care indicator by the Taiwan Bureau of National Health Insurance in the same year, the rate was significantly lower. As the survey results indicated, reasons for the low funduscoptic examination implementation rate were (1) the lack of knowledge; (2) a funduscoptic exam cannot be completed during one outpatient clinic visit; and (3) the complicated procedure of a funduscoptic examination. To improve these problems, solutions adopted in this project were (1) enhancing health education regarding funduscoptic exams; (2) training professional inspectors; (3) increasing clinic hours for eye exams; (4) assisting funduscoptic examination arrangements and simplifying the funduscoptic examination process. Results obtained from the solutions, the implementation rate of the funduscoptic exam rose from 11% to 65%. The alternatives had achieved goals of the project. This can also serve as a reliable reference of problem-solving for the diabetic care professionals.

並列關鍵字

Diabetes ； Retinopathy ； funduscoptic examination