台中縣糖尿病共同照護網評價研究

The Evaluation of Diabetes Shared Care Program In Taichung County

楊惠如(yang hui ju)

指導教授 ： 何清松 ； 葉彥伯

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

有效的品質監控及稽核評價機制，對於建立一適宜之糖尿病照護模式及進行醫療糖尿病照護品質改善而言，是相當重要的基礎。本研究目的是將糖尿病照護所需的評價指標作系統的整理，用以評價台中縣2002至2006年共同照護之推動成效，以做為未來糖尿病照護成效改善計畫的參考。
本研究為次級資料分析，資料擷取自台中縣糖尿病照護服務資訊系統中2002至2006年照護資料檔，以SPSS12.0及EXCEL視窗版軟體進行資料處理及分析。研究中針對醫療體系分工整合、照護品質改善及照護模式發展三個面向，分別選定適當之評量指標，評價2002至2006年台中縣糖尿病共同照護網照護成效，並針對區域醫院、地區醫院、衛生所，基層診所、簡易照護5種不同照護模式進行探討；
結論如下：
(一) 台中縣基層糖尿病個案照護模式及品質監控計畫的執行可有效促進基層診所轉型為健康促進機構。
(二) 2006 年執業醫事人員中合格糖尿病衛教人員（以下簡稱CDE）之比率台中縣最高，顯示台中縣在CDE 的推廣優於中區及全國，可能與台中縣衛生部門的政策支持有關。
(三) 台中縣2004 及2005 年改善方案之失落率低於簡易照護，顯示改善方案提供以病患為中心的共同照護服務，確能提昇糖尿病治療指引遵循率。
(四) 複診照護及年度照護完成率隨世代逐年增加，顯示改善方案之個案照護順從性越來越好。
(五) 台中縣2006 年改善方案照護成果，除A1c>9.0%達DPRP 標準外，其他評量項目均未達DPRP 標準，甚至落後ADA 之差距達10 年之久。
(六) TADE 改善方案各評量項目成效均優於台中縣改善方案，主要原因可能是由於TADE 調查對象為健康促進機構，對照護品質要求比一般參加改善方案之院所更為嚴謹。
(七) 評量台中縣2002 年至2006 年間各項檢查完成率，結果發現管理完成率最高的是低密度脂蛋白、糖化血色素和足部檢查，顯示此3 項是病患較易接受之檢查項目。
(八) 基層醫療資源的整合、一致性作業規範的訂定及衛生所公衛護士的個案管理，可提高眼睛（視網膜散瞳）檢查及腎病變檢查的完成率。
(九) 台中縣5 種照護模式之足部檢查人數完成率呈現逐年提升的趨勢，可能由於足部檢查容易執行，且護理人員盡責度較高。
(十) 醫師加入戒菸治療計畫確能提高個案戒菸諮詢的比率，未來應繼續鼓勵糖尿病共同照護網醫師參與戒菸治療計畫，使能提高個案戒菸諮詢完成率。
(十一) 糖尿病照護涉及複雜的照護體系整合及團隊照護品質的持續改善。標準化的資料系統與指標，建立定期公佈的全國性或區域性照護品質監測機制是未來糖尿病照護的重點目標，本研究係將糖尿病照護所需的評價指標作系統的整理，其結果可提供各縣市推動糖尿病共同照護網之參考。

關鍵字

糖尿病共同照護網、糖尿病醫療服務改善方案試辦計畫、糖 化血色素、糖尿病品質改善計畫

並列摘要

The purpose of this research is to proceed a systematic review of the indicators for the care of the diabetes patients, and to evaluate the effectiveness of cooperative care model in Taichung County from 2002 to2006.
The data analyzed in this study was retrieved from the information database of the care of diabetes patients system in Taichung County from 2002 to 2006. the major finding are listed below:
(1) The execution of Taichung county diabetic patients care plan can promote the transition of basic clinic into health promotion institutions.
(2) The ratio of CDE to medical personnel is the highest in Taichung county in 2006, the population of CDE in Taichung county is superior to the center district and the whole country, the support from the hygiene department of Taichung county may play a important role.
(3) The patients’ loss rate from the improvement program is lower than the simple care program, it reveals the improvement program offer the cooperative care service which regard patient as the center, can significantly promote the diabetic patients treatment and the following rate.
(4) The accomplishment ratio of continuing care and annual care increases with the coming year, it reveals the patients who joined his program have better obedience.
(5) According to the data in Taichung county in 2006, Except the indicator of A1c> 9.0%, all the other indicators of the whole program don't reach DPRP standard.
(6) All the indicators of TADE improvement program are shown to be superior to those of Taichung county improvement program; the main reason may be related to the subjects who evaluated by the TADE were health promotion institutions, and the standards are more severe.
(7) The items which have the higher accomplishment ratio were blood pressure, HbA1c and foot inspection from 2002 to 2006 in Taichung County, it reveals that these 3 items are easier to be accepted by the patients.
(8) The integration of basic medical resources, setup of the definition of normal standard and case management procedure for the public health nurses in health center, can improve the accomplishment ratio of eyes and kidney pathological inspection of the diabetic patients.
(9) The foot inspection accomplishment ratio of the diabetic patients from 5 care models in Taichung County appears improving from the recent years, the major reasons maybe include that the feet inspection were easy to carry out, and nursing staff were highly responsible.
(10) The participation of doctor in smoking cessation plan improve the joining rate of smoking cessation consultation; it is important to
encourage doctors to join the diabetes patients care cooperative network participating in smoking cessation plan.
(11) The diabetes patients care are the complicated combination of care resources and the lasting improvement of group care quality. The key goals of future diabetes patients care are to establish the standard data system and indicators of the institution, the monitor mechanism for care quality. This research broaches the reference indicators for the care of diabetes patients to promote the performance the diabetes patient cooperative care network.

並列關鍵字

Shared Care Net work for the Diabetes, Shared Care Disease Management Program for the Diabetes, Hemoglobin A1c, Diabetes Quality Improvement Program

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