參與論質計酬方案對接受冠狀動脈繞道手術之糖尿病病人之預後影響

The Impact of a Pay for Performance Program on the Outcome after a Coronary Artery Bypass Graft in Diabetic Patients

10.6288/TJPH201332101066

鍾文誠(Wen-Cheng Chong)；吳肖琪(Shiao-Chi Wu)；李曉伶(Hsiao-Ling Lee)

冠狀動脈繞道手術 ； 糖尿病 ； 糖尿病論質計酬方案 ； coronary artery bypass graft surgery ； diabetes ； pay for performance program

台灣公共衛生雜誌

32卷6期（2013 / 12 / 15）

615 - 625

繁體中文

目標：探討接受冠狀動脈繞道手術之糖尿病病人參與論質計酬方案對術後感染及死亡情形之影響。方法：採用回溯性世代研究法，以全民健保2009－2010年間接受冠狀動脈繞道手術之成年糖尿病病人為研究對象。利用趨勢檢定參與糖尿病論質計酬方案程度對接受冠狀動脈繞道手術之糖尿病病人之預後關係。結果：未參與糖尿病論質計酬方案者佔80.92%、未連續參與者佔13.55%、連續參與者僅佔5.53%；術後30、90日感染情形，皆以連續參與組最低，分別為3.00%及3.06%；未參與組最高，為6.89%及8.88%；校正後的OR值分別為0.92及0.33。術後30、90日死亡情形，亦是連續參與組最低，分別為1.96%及3.92%；未參與組最高，為5.49%及9.24%；校正後的OR值分別為0.52及0.44，趨勢檢定達顯著差異。結論：參與糖尿病論質計酬方案之病人在接受冠狀動脈繞道手術後之感染及死亡風險皆較未參與者低，可作為衛生主管機關加強鼓勵糖尿病病人參與論質計酬方案之參考，同時鼓勵醫療院所提升糖尿病論質計酬方案之涵蓋率，以減少日後糖尿病病人之術後併發症的發生。

Objectives: The aim of this study was to explore the impact of a pay for performance program on the outcome after coronary artery bypass graft surgery (CABG) in diabetic patients. Methods: This study employed a retrospective cohort study design, and the study subjects were adult diabetic patients who underwent CABG during 2009-2010. A trend test was used to evaluate the relationship between participation in the pay for performance program and the outcome. Results: Among the diabetic patients undergoing CABG, those who did not participate in the pay for performance program accounted for 80.92%, those with non-continuous participation accounted for 13.55%, and those with continuous participation accounted for 5.53%. Infection rates within 30 and 90 days after operation were lowest in the continuous participation group (3.00% and 3.06% respectively) compared to 6.89% and 8.88% in the non-participation group. The adjusted ORs were 0.92 and 0.33. The trend test showed significant differences. Death rates within 30 and 90 days after operation were also lowest in the continuous participation group (1.96% and 3.92% respectively) compared to 5.49% and 9.24% in the non-participation group. The adjusted ORs were 0.52 and 0.44. Conclusions: Participation in a pay for performance program lowered the postoperative infection and death risks for diabetic patients. Health authorities should make greater efforts to encourage diabetic patients to participate in a pay for performance program, and also encourage medical institutions to improve coverage for pay for performance programs. For diabetic patients in the program, medical institutions should follow-up and guide patients to receive continuous care in order to reduce or delay the occurrence of comorbid conditions and postoperative complications.

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