醫療給付改善方案與照護過程對糖尿病病人健康結果之影響

譚家惠

doi:10.6342/NTU.2013.01947

山西大学，您好！

感谢采购，人社期刊库｜人社论文库，期间：2025/01/01~2025/12/31

感谢试用，科学期刊库｜科学论文库，期间：2024/10/20~2025/01/20

浏览高级检索

关闭
检索检索高级检索出版物检索
浏览期刊主题浏览核心期刊浏览期刊拼音浏览

关闭

查询符号(半角)	查询符号意义说明
空格	表示为「AND」两个查询词之交集
双引号 ( " " )	片语以双引号标示开始及结束，而且只寻找出现顺序相同的字词，例： " image process "
?	表示一个字母切截，输入两个?表两个字母，依此类推，例：输入「Appl?」，查得结果应为appl e , appl y … ( 常用于英文字查询 )
*	表示不限字母切截，由0~n. 例：输入「appl*」，查得结果应为appl e , appl es , appl y , appl ied , appl ication … ( 常用于英文字查询 )
AND、OR、NOT	布尔逻辑组合关键字，用来扩大或缩小查询范围的技巧。 (1) AND ：缩小查询范围 (2) OR ：扩大查询范围(3) NOT：排除不相关的范围

DOI 是数位物件识别码（ D igital O bject I dentifier ）的简称，
为物件在网路上的唯一识别码，可用于永久连结并引用目标物件。

使用DOI作为永久连结

每个DOI号前面加上「 http://dx.doi.org/ 」便成为永久网址。
如以DOI号为 10.5297/ser.1201.002 的文献为例，此文献的永久连结便是： http://dx.doi.org/ 10.5297/ser.1201.002 。
日后不论出版单位如何更动此文献位置，永久连结所指向的位置皆会即时更新，不再错失重要的研究。

引用含有DOI的文献

有DOI的文献在引用时皆应同时引用DOI。若使用APA、Chicago以外未规范DOI的引用格式，可引用DOI永久连结。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。

书目管理工具

相关连结

问题回报

全文下载

医疗给付改善方案与照护过程对糖尿病病人健康结果之影响

The Effects of Pay-for-Performance and Process of Care on Health Outcomes of Diabetic Patients

谭家惠 , 博士　　导师：杨铭钦　　

繁体中文 DOI： 10.6342/NTU.2013.01947

糖尿病；论质计酬；并发症；心血管疾病；倾向分数法； diabetes ； pay-for-performance ； complication ； cardiovascular disease ； propensity score method

0 个人觉得这篇文章赞

摘要 │ 参考文献 (165) │ 被引用文献 (1) │ 国际计量

摘要〈TOP〉

并列摘要〈TOP〉

Objective: A number of studies have examined the impacts of pay-for-performance programs on quality of care, but little is known about long-term effects of these programs on the health care outcomes. 
Objective: The study aimed to examine the effects of the pay-for-performance program for type 2 diabetes patients on diabetes-related complications.
Materials and methods: A longitudinal cohort study with 5-year follow-up was used to evaluate the impact of pay-for-performance program on diabetes-related complications. Research materials came from claims files of the Longitudinal Health Insurance Database (LHID) 2005 released from the Nation Health Research Institute. Patients newly diagnosed as diabetes (with more than 3 times of ambulatory visits diagnosed as diabetes [ICD-9-CM: 250.xx] or 1 time hospitalization with major diagnosis of diabetes) in 2004-2006 were included in the study. The case group were defined as joined the pay-for-performance program and received the comprehensive care over 12 months during 2004 to 2010. The control group were defined as never joined the pay-for-performance program during follow-up period. Patients who involved the pay-for-performance program or not is not randomization, we applied the propensity score matching (PSM) as a mean to increase the comparatives between these two groups. The incidences of six diabetes-related complications, including retinopathy, neuropathy, nephropathy, cerebrovascular, cardiovascular, peripheral vascular disease and metabolic disease) were analysed. 
Different propensity score methods and survival analysis were use to estimate whether involved in the pay-for-performance program was able to decrease the risk of cardiovascular events for diabetes patients. The SAS v9.3 package software was used the database process and statistical analyses.
Results: Patients with newly diagnosed diabetes who participated in the pay-for-performance program for over 12 months experienced cardiovascular event significantly later than non-participants. The marginal hazard ratios of different propensity score method ranged from 0.60 to 0.63. There were significantly different risk of heart failure, myocardial infarction and stroke between those participated in the pay-for-performance program for over 12 months and those did not. Of these propensity score methods, propensity score matching and inverse probability of treatment weighting (IPTW) using propensity score resulted in the estimate with lower standardized difference of means between participant and non-participant groups. 
Conclusions: Cardiovascular events were significantly reduced over 5-year period among patients newly diagnosed with diabetes who participated in the pay-for-performance program for over 12 months. When estimating relative effects of interventions, propensity score matching and IPTW using the propensity score were recommended to apply to reduce the systematic bias between groups.

参考文献 ( 165 ) 〈TOP〉

Adler, A. I., R. J. Stevens, S. E. Manley, R. W. Bilous, C. A. Cull, R. R. Holman and U. Group (2003). "Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)." Kidney International 63(1): 225-232.
连结：
American Diabetes Association (2010). "Standards of Medical Care in Diabetes-2010." Diabetes Care 33: S11-S61.
连结：
Arday, D. R., B. B. Fleming, D. K. Keller, P. W. Pendergrass, R. J. Vaughn, J. M. Turpin and D. A. Nicewander (2002). "Variation in diabetes care among states - Do patient characteristics matter?" Diabetes Care 25(12): 2230-2237.
连结：
Austin, P. C. (2009). "Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples." Statistics in Medicine 28(25): 3083-3107.
连结：
Austin, P. C. (2009). "The Relative Ability of Different Propensity Score Methods to Balance Measured Covariates Between Treated and Untreated Subjects in Observational Studies." Medical Decision Making 29(6): 661-677.
连结：

被引用文献 (1) 〈TOP〉

蔡茜如(2014)。糖尿病医疗给付改善方案、照护过程品质与可避免住院之相关性探讨。国立台湾大学健康政策与管理研究所学位论文。2014。1-98。

国际计量

〈TOP〉

E-mail ：

文章公开取用时，将寄通知信至您填写的信箱地址

E-mail ：

使用DOI作为永久连结

引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。