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  • 學位論文

糖尿病病人參與糖尿病共同照護網成效之評估

The Study of the Effectivenes of the Diabetes Participated in the Diabetes Shared Care Network

指導教授 : 楊哲銘

摘要


本研究目的主要在探討並評價糖尿病共同照護網的成效。 研究方法採用1998~2008年健保資料庫百萬歸人檔,研究期間自西元2002年至2004年每年新發生糖尿病病人,共12,958人,其中920人有參與糖尿病共同照護網疾病管理,12,038人未參與糖尿病共同照護網疾病管理(特定治療項目代號E4),往後連續各分析4年分別至2006、2007、2008年,統計主診斷或次診斷為糖尿病(ICD-9-CM碼為250)疾病之平均門診次數及總費用,平均急診次數及總費用,平均住院次數、平均住院日數,平均住院總費用及平均醫療總費用之差異;另統計糖尿病新發病者(2002至2004年)罹患糖尿病相關慢性病及併發症(發生時間由1998追蹤至2008年),罹患相關慢性病、併發症之比率及共病校正後的影響。 研究結果:每年新發病的糖尿病病人皆是男性多於女性,有參加糖尿病共同照護網之發病年齡低於未參加者平均2~5歲,有參加計劃者平均收入均高於未參加者。而無論是哪個年度或是計畫介入幾年後,門診的次數跟費用,都是有參加糖尿病共同照護網計畫組顯著的偏高。在分析有無參加糖尿病計劃者之糖尿病的併發症罹病機率來看,以2002至2004年所有新罹患糖尿病者資料(12,958人)的併發症或共病校正後發現,在控制其餘變項(年紀、性別、收入、醫院所在地區、醫院層級、冠心症、中風、高血壓、腎臟病變、視網膜病變、末稍神精病變、周邊血管病變、其餘糖尿病相關病變)所造成的影響後,發現參加計劃的有無確實與糖尿病病患罹患相關慢性病及併發症相關。另經過皮爾森相關分析結果,發現醫療總費用與:是否參與計劃、年齡、性別、及八大糖尿病相關慢性病及併發症有顯著相關性。 研究結論:糖尿病病人有參加糖尿病共同照護網計畫者,雖然其平均門診的次數及費用較多,但糖尿病慢性病及併發症,一共分析八個疾病(冠心症、中風、高血壓、腎臟病變、視網膜病變、末稍神精病變、周邊血管病變、其餘糖尿病相關病變)採共病校正(年紀、性別、收入、醫院所在地區、醫院層級、冠心症、中風、高血壓、腎臟病變、視網膜病變、末稍神精病變、周邊血管病變、其餘糖尿病相關病變)後發現,糖尿病患者參加計畫的有無與糖尿病患罹患相關慢性病及併發症有高度相關。

並列摘要


The purpose of the study was to investigate and evaluate the effectiveness of the Diabetes Shared Care Network. The database of millions personal files owned by the National Health Insurance, and those still alive in 2008, were applied in this study. The period was from AD 2002 to 2004. The number of new diabetes patients, or those that participated or didn’t participate in the Diabetes Shared Care Network were analyzed for four continuous years to AD2006, 2007, and 2008. The statistics showed primary or secondary diagnosis of the average outpatient visits and the total cost of 250 diseases, the average emergency department visits and the total cost, the average number of hospitalizations, the average length of stay, the average hospital costs and the average differences in the total medical expenses; statistics of new cases of diabetes (AD2002-2004) with diabetes-related chronic diseases and complications (occurrence time tracking from AD1998 to 2008), and suffering related to chronic disease, after correction for the ratio of complications and co morbidities impact. Through the Pearson correlation coefficient analysis, the total medical costs were significantly related with the following: participants or non-participants in the plan, age, gender, and eight diabetes-related chronic diseases and complications. The results showed that the new diabetic patients were more men than women. For those participated in Diabetes Shared Care Network were 2 to 5 years younger than non-participants, but the average income was higher than non-participants. Regardless of which year after the intervention, the number of times with the cost of out-patients, were significantly higher for those participated in the Diabetes Shared Care Network. In the data from AD2002 to 2004, 12,958 people suffer from diabetes complications or co morbidity corrected in the analysis of whether to participate in the complications of diabetes plans, if the remaining variables (age, the impact of gender, income, hospital area, the hospital-level and seven complications) were fixed, participants or non-participants were related to diabetes patients suffering from chronic diseases and related complications. The study concluded that patients with diabetes to participate in the Diabetes Shared Care Network plan group, although the average numbers of outpatients and costs increased, but the diabetes chronic diseases and complications, a total analysis of the eight diseases (coronary heart disease, stroke, hypertension, kidney disease, retinopathy, peripheral neuropathy change, peripheral vascular disease, and other diseases) collected a total of disease correction (age, gender, income, hospital area, the hospital level and seven complications), and diabetes patients participated in the program whether suffering from chronic diseases and complications were highly correlated with diabetes. Regardless of which year or plan of intervention after a few years kidney disease, and peripheral neuropathy, has shown that there were significant differences in the total medical expenses or out-patient total cost of its costs. Therefore, it was recommended that a comprehensive plan for people with diabetes, routine checks should include urine routine, renal function, fondues examination and nerve conduction studies.

參考文獻


行政院衛生署國民健康局糖尿病防治手冊(92年12月)
行政院衛生署國民健康局慢性腎臟病防治手冊(99年12月)
行政院衛生署國民健康局
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譚健民 : 2011年美國糖尿病協會(ADA)糖尿病診療標準指引摘要,臺灣醫界,2011, Vol.54, No.3。

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