Utilization of Patients Enrolled in the Shared Care Disease Management Program for Diabetes - An Example from a Regional Teaching Hospital

Cheng-Lin Tsai ； Ling-Ling Yeh ； Chih-Liang Yaung ； Wayne H-H Sheu

《Formosan Journal of Endocrinology and Metabolism》 1卷1期 (2009/10) Pp. 6-15

https://doi.org/10.6856/FJEM.200910_1(1).0002

摘要

The study aims to investigate patient medical utilization after their participating in the Share Care Disease Management Program and to explore the impact of education on these utilization. This is a retrospective cohort study. A total of 487 subjects with type 2 diabetes were selected from 1243 patients who had joined this program. These patients had been in the program for at least 25 months. They had received at least 684 days medication (90% of the observed duration) and at least four education sessions from nurses and dietitians. Analysis of the diabetes-related utilization showed that outpatient expenses increased when the patient had a high level of baseline hemoglobin a1c (Hba1c), had severe complications, were overweight or obese, had a longer duration after diagnosis and had undergone more diabetes education. Emergency expenses increased when the patient was using insulin injections, but decreased with more diabetes education. Admission expenses increased with a longer duration after diagnosis, hypercholesterolemia and a high level of baseline Hba1c but decreased with more diabetes education. Outpatient visits increased with severe complications. Emergency visits, admission frequency and admission days decreased with more diabetes education (all p＜0.05). The most important factors associated with increased utilization were a long duration of diabetes and severe diabetes complications. Although more diabetes education caused greater diabetes-related outpatient expenses, this education was effective and decreased many other aspects of medical utilization.

關鍵字

Shared care disease management program for diabetes ； Medical utilization