氣喘疾病管理在醫療資源耗用、臨床指標改善與自我照護能力的影響

The Effects of Controlling Health Service Utilization, Improvement of Clinical Outcomes, and Promoting Self-management Care Ability under Asthma Disease Management

劉貞娟(Chen-Chuan Liu) ； 翁慧卿(Hui-Ching Weng) ； 蔡魯(Lu Tsai)

《福爾摩莎醫務管理雜誌》 2卷1期 (2006/06) Pp. 36-46

https://doi.org/10.6771/FJHA.200606.0036

摘要

目的：本研究在探討，中央健康保險局透過氣喘疾病管理是否控制氣喘醫療費用支出，改善病患的臨床症狀及提升自我照護能力。方法：本研究是利用健保局南區分局2000年11月至2003年12月醫療費用的申報資料進行分析。比較完成照護的完成組（450人）前後測改變情形，及比較完成組與未完成組（1423人）在臨床症狀和醫療資源使用情形的差異。最後並調查參與實驗計畫病患氣喘自我照護能力改善狀況。結果：447位完成組的疾病嚴重度在經過照護後確實顯著的減輕症狀，有75.8%的人病狀未再惡化。396位完成組的PEF值在經過完整照護後也有顯著的提升效果，PEF上升50.56L/min；完成組加入計畫後一年的急診及住院醫療使用比未完成組低；完成組後測比前測的急診及住院醫療使用有明顯的下降且較未完成組下降更多；參加試辦計畫的氣喘病患，診療過程中經由醫護人員指導後，覺得有提升自我照護能力者超過95%。結論：健保局推行的氣喘疾病管理計畫成效良好，應積極推廣於全國，並供其他慢性病疾病管理方案之決策參考。然初期費用較高，健保當局應加強對院所的輔導與監督，並建立論質計酬給付點數制度，以維疾病管理的永續經營。

關鍵字

氣喘 ； 疾病管理 ； 論質計酬 ； 醫療費用

並列摘要

Objectives The aim of this study was to make sure that the effectiveness of the asthma disease management would decrease medical care costs, and improve clinical outcomes and patients' self-care management. Methods By using the BNHI Southern Region Branch database, the study investigates the health service utilization of asthma between November 2000 and December 2003. Enrollees comparison of pretest and posttest of health service utilization were conducted for 450 patients (complete group), who enrolled in the program, and for the incomplete group of 1423 patients who did not complete the program. Results Among 450 patients (complete group), 447 patients had significant improvement in minimizing incidences of asthma forrelated symptoms. Also 396 patients had significant improvement in the pulmonary function test. There also showed a significant reduction (-50.1%~-66.7%) in emergency and hospitalization health care costs for complete group under asthma disease management for one year. Furthermore, patients in the complete group had improvement in emergency and hospitalization health care costs, reduction compared with the incompletes. More than 95% patients agreed that the program enhanced their self-care management skills. Conclusions These results show the greater significance of the programs promoted by BNHI, Taiwan. With awareness of growing prevalence of asthma, the policy-makers should begin to find the solution for controlling the growing health service expenditure caused by asthma, and to establish a favorable pay-by-quality reimbursement system for sustaining disease management.

並列關鍵字

asthma ； disease management ； pay by quality ； health care costs