[[alternative]]A Study on Quality Indicators of Medical Treatment in Diabetes Through Disclosure of Quality Information in National Health Insurance.

[[abstract]]背景：臺灣人口之平均餘命不斷增加，加上物質生活日益豐富及日常運動量日趨下降等環境變化因素，使得糖尿病的盛行率逐年升高，連帶帶來龐大的醫療成本。有鑑於此，行政院衛生署中央健康保險局(2013年7月23日改制為衛生福利部中央健康保險署，以下內文皆以改制後名稱敘述)自2001年11月實施「全民健保糖尿病醫療給付服務改善方案」，針對那些醫療過程面指標表現好的醫療提供者增加給付，以鼓勵醫療提供者給予更好的照護品質。目的：本研究擬探討「全民健保糖尿病醫療給付服務改善方案」所公開的品質指標概況、評估各項指標在不同情境條件的表現是否有差異，並探討影響糖尿病品質四項指標執行率的因素。方法：本研究採用衛生福利部中央健康保險署「糖尿病醫療品質資訊」網站公開之指標資訊，資料期間範圍為2008年至2012年，以年為觀察單位，分析醫院於五年觀察期間，全國糖尿病患之醫療品質指標的變化概況，以SPSS20.0 套裝統計軟體進行資料處理及分析。結果：1.糖尿病患人口數由2008年的1,286,846人，至2012年上升到1,538,565人，而且2012年病患就醫機構20%在醫學中心、27%在區域醫院、16%在地區醫院、37%在診所；地區醫院的病患數由2008年的216,975人，到2012年上升到236,925人，成長8%，最持平，無顯著成長，診所與區域醫院的病患數則較明顯地呈逐年遞增的狀態，診所由2008年的467,209人，2012年上升到570,188人，成長41%；區域醫院則是由2008年的338,911人，2012年上升到421,557人，成長32%。2.不同特約類別醫事機構的糖尿病病患中重大傷病患數的佔率，醫學中心的比率最高為19.33%，診所則顯著最低，平均為8.04%。3.就加入試辦計畫的醫事機構類型來看，2008年至2012年醫學中心維持20家、區域醫院維持80多家、地區醫院或有消長由2008年的365家到2012年的345家，只有診所加入試辦計畫的院所數是逐年上升，由2008年的5,419家上升到2012年的6,051家。4.糖化血色素檢查之執行率最高，五年平均值為67.13%，眼底檢查或眼底彩色攝影及尿液微量白蛋白檢查執行率則偏低，約18%。5.至於影響糖尿病品質指標表現差異的因素，經由變異數分析與迴歸分析後，可以發現病患平均年齡、病患重大傷病比率、糖尿病照護試辦計畫參與醫師數等數值越高，糖尿病醫療品質指標越好。結論：糖尿病四項品質指標整體執行率逐年上升。[[abstract]]Background: The population of average life expectancy continuously increase in Taiwan within the environmental factors of increasingly rich material life and decreasing daily physical activities, which leads the prevalence of diabetes has been increased every year, and hence, towards to vast healthcare costs. According to this phenomenon, the Bureau of National Health Insurance (transformed to National Health Insurance Administration, Ministry of Health and Welfare on July 23rd, 2013) began to implement “The Diabetes Medical Benefit Improvement Project of National Health Insurance” since November 2001. This project attempts to provide more payments to encourage the healthcare providers who have offered better quality of medical treatment among assigned process indicators.Objectives: The aim of this study is to investigate the healthcare quality indicators assigned in the project and evaluate the difference of performance in each indicator under different circumstance, and try to find out the factors which will affect the performance of these healthcare quality indicators from “The Diabetes Medical Benefit Improvement Project of National Health Insurance”, and to explore the factors that affect the execution rate on quality of the four indicators of diabetes. Methods: SPSS20.0 statistic software will be adapted to data management and analyze within collected information in this study, the study on quality indicators of medical treatment in diabetes through disclosure of quality information in National Health Insurance Administration, Ministry of Health and Welfare between 2008 and 2012. The study observed the changes of health care quality indicators in the five years base on one-year unit and observed samples cover all of Taiwan's diabetes. So called diabetes were the patients who diagnosed as diabetes in their major OPD and taking anti-diabetes medicine after the diagnosis. Results: The major findings in this study1.For the demographic characteristics of diabetes patients, the number of diabetes patients has been increasing from 1,286,846 in 2008 to 1,538,565 in 2012, the ratio of patients distribution were 20% in medical centers, 27% in regional hospitals , 16% in area hospitals, and 37% in clinics. The patient number was from 216,975 in 2008 to 236,925 in 2012 with 8% growth in area hospitals which is the most non-significant growth among all compared to the significant growth in clinics and regional hospitals. The patient number was from 467,209 in 2008 to 570,188 in 2012 with 41% growth in clinics and from 338,911 in 2008 to 421,557in 2012 with 32% growth in regional hospitals. 2.The ratio of major injury with diabetes patients in different categories was also quite different, the highest rate was 19/33% in medical centers, the lowest rate was average of 8.04% in clinics. diabetes patients.3.From the type of medical institute joined the project, there were 20 medical centers remained the same, more than 80 regional hospitals also maintained. For area hospitals, was from 365 in 2008 decreased to 345 in 2012. Only the number of clinics to join the project was increasing year by year, from 5,419 in 2008 rose to 6,051 in 2012.4.The highest execution rate is checking glycated hemoglobin, the five-year average rate is 67.13%, the execution rate of fundus examination or fundus photography and urine microalbumin examination is relatively low around 18%. 5.As for the factors affecting the performance differences of diabetes quality indicators through analysis of variance and regression. We found the higher of patients’ average age, major injuries patients ratio, doctor number who joined this project, the better of medical quality index for diabetes patients.Conclusion: The overall execution rate of four quality indicators of diabetes is increasing yearly