糖尿病醫療給付改善方案、照護過程品質與可避免住院之相關性探討

蔡茜如

doi:10.6342/NTU.2014.02265

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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

Association Between A Pay-for-Performance Program, Process Quality and Avoidable Hospitalizations for Diabetes Care

蔡茜如 , 硕士　　导师：锺国彪　　

繁体中文 DOI： 10.6342/NTU.2014.02265

糖尿病论质计酬；照护过程品质；可避免住院；多层次分析； pay-for-performance ； process quality ； avoidable hospitalizations ； multilevel analysis

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摘要 │ 参考文献 (79) │ 国际计量

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Background: The diabetes-related complications can be prevented from getting worse by quality of ambulatory care and proper treatment. Therefore, more and more studies are using avoidable hospitalizations as the measurement to evaluate the quality and the accessibility of primary care. However, a number of studies have examined the impacts of pay for performance programs on the process quality and healthcare utilization, but little is known about the quality measurement of outcome.

Objective: The study aimed to examine the association between a pay-for-performance program, process quality and avoidable hospitalizations for diabetes care. And to examine the effect of cross-level interaction between patient-level and physician-level on process quality.

Methods: A longitudinal cohort study with 3-year follow-up. New-onset diabetes patient were selected in 2004-2005 form National Health Insurance Research Database. Using generalized estimating equations to examine the association between the pay-for-performance program, process quality and avoidable hospitalizations for diabetes care after adjustment for the characteristics of patients. Furthermore, to examine weather process quality may mediate the relationship between the pay-for-performance program and avoidable hospitalizations. Finally, by using multilevel analysis, to examine the effect of cross-level interaction between patient-level and physician-level on process quality.

Results: Patients who participated in the pay-for-performance program have a lower probability of avoidable hospitalizations and have a better process quality of care. The patients who had a better process quality of care may also have a lower probability of avoidable hospitalizations. Patients’ quality of care on process may be influenced by primary care physicians' gender, age, specialist and hospital. Primary care physicians' specialist and hospital also have cross-level interaction on participating in the pay-for-performance.

Conclusions: Participating in the pay-for-performance program is an effective way to improve the process quality and to reduce the probability of avoidable hospitalizations for diabetes care. Had a better process quality may also reduce the probability of avoidable hospitalizations. Patients’ quality of care on process may be influenced by primary care physicians' characteristics. In order to evaluate the effect of policy more deeply, further researches could quantify the severity of avoidable hospitalizations, like times, costs, etc.

参考文献 ( 79 ) 〈TOP〉

Agabiti, N., Pirani, M., Schifano, P., Cesaroni, G., Davoli, M., Bisanti, L., . . . Marinacci, C. (2009). Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC public health, 9(1), 457.
连结：
Amer Diabet, A. (2013). Standards of Medical Care in Diabetes-2013. Diabetes Care, 36, S11-S66. doi: 10.2337/dc13-S011
连结：
Association, A. D. (2000). Standards of medical care for patients with diabetes mellitus. American Diabetes Association. Tenn Med, 93(11), 419-429.
连结：
Billings, J., Anderson, G. M., & Newman, L. S. (1996). Recent findings on preventable hospitalizations. Health Affairs, 15(3), 239-249. doi: 10.1377/hlthaff.15.3.239
连结：
Billings, J., Zeitel, L., Lukomnik, J., Carey, T. S., Blank, A. E., & Newman, L. (1993). Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood), 12(1), 162-173.
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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（）。