[[alternative]]The accountability of provider and effects evaluation of shared care for patients with diabetes

[[abstract]]背景：1996年8月在宜蘭縣開始推行糖尿病共同照護網試辦計畫，是以疾病管理的概念管理糖尿病人。目前糖尿病預防與健康保險結合，在全台推動糖尿病共同照護模式的照護。至今糖尿病共同照護相關的研究多是以建置共同照護的經驗分享，而我們要更進一步了解糖尿病共同照護模式的照護品質與成效。目的：評估糖尿病共同照護網之醫療機構，提供糖尿病人照護過程的盡責度，進一步評估照護成效。材料：北部某區域醫院於2002年9月至2003年5月有接受及沒有接受糖尿病共同照護的糖尿病人；中部某地區醫院於2002年4月至2003年4月有接受及沒有接受糖尿病共同照護的糖尿病人。方法：以羅輯司迴歸分析兩家醫院的糖尿病人，其接受糖尿病共同照護之後所受到的照護品質，並運用廣義估計方程式分析接受糖尿病共同照護之前與之後重複測量的血糖控制情形。結果：接受糖尿病共同照護的病人在照護品質指標的檢驗，如：糖化血色素、脂質、尿微量白蛋白等檢驗，比沒有接受糖尿病共同照護的病人次數多。糖尿病人接受糖尿病共同照護照護之後，其糖化血色素值的表現比沒有接受糖尿病共同照護的病人好。[[abstract]]Context: The experimental plan for shared care network on diabetes patients started in Yilan country in August of 1996; it is based on the concept of disease management to manage diabetes patients. In combination with health insurance nowadays, the prevention of diabetes and shared care model for diabetes patients is developing all over Taiwan. Up till now, the related studies on shared care for diabetes patients are mostly based on experience sharing from shared care; however, we are going to take one step further to understand the effects of shared care model on diabetes patients.Purpose: To evaluate the accountability of provider and the effects of treatment from shared care network for patients with diabetes.Samples: Diabetes patients with and without shared care from a region hospital in the northern Taiwan area during the time period of September 2002 and May 2003; diabetes patients with and without shared care from a hospital located in the central Taiwan area during the time period of April 2002 and April 2003.Methods: Used logistic regression analysis to analyze the care quality of both hospitals’ diabetes patients after shared care; also applied generalized estimating equations to analyze the control condition of blood sugar, before and after shared care for patients with diabetes.Results: The diabetes patients with shared care had more medical tests which indicated they had better care quality than those without shared care; these medical tests includes: HbA1c test, lipid profile test and Urine microalbumin test. The diabetes patients after being shared cared, their HbA1c values are better than those without shared care