Case Management of Type 2 Diabetes Mellitus in a City Hospital

社區型醫院第二型糖尿病個案管理

10.6200/TCMJ.2006.3.3.05

洪建德(Chien-Te Hung)

第二型糖尿病 ； 個案管理 ； 流程指標 ； 結果指標 ； 約診與排程 ； type 2 diabetes mellitus ； case management ； process indicators ； outcome indicators ； appointments and schedules

北市醫學雜誌

3卷3期（2006 / 03 / 01）

226 - 239

英文

Background and Purpose: The study was aimed to describe our case management of diabetes turning from local to national health insurance version. Methods: The study sample was defined 1008 old patients and 309 new patients from April to December in 2002. The 'old patients', those who being regularly treated over six months plus new patients, those who came at first time were defined. Results: The process indicators of measuring body weight, blood pressure, and blood glucose per month were executed over 93%, if being corrected with execution per visit instead of per month, and then the rates increased to over 99%. The process indicator of fundus examination was executed over 99%. The A1C and microalbuminuria were executed 82% and 89%. Due to some patients delayed the examination till next visit the corrected rate of A1C to 7month increase to 93%. There was no gender preponderance. The retinopathies by fundoscopic examination in both groups did not show any significant differences, p=0.0180 by fisher’s exact test. The diastolic blood pressure did show a significant difference for group and time effect by repeated measure of random effect model, on the other hand the systolic blood pressure was not the case in group and time effect, p=0.176. The anteprandial sugar were significant different for group and time tested by repeated measure of random effect model and the postprandial sugar did show only time by the same method. The A1C did show a significant difference in the first month and thereafter not any more significant. The average waiting time was 15±11 minutes. Conclusion: The cross sectional observation for 9 months suggested that a retrospective and prospective review of the management must be very interesting to show the effect of the management.

Background and Purpose: The study was aimed to describe our case management of diabetes turning from local to national health insurance version. Methods: The study sample was defined 1008 old patients and 309 new patients from April to December in 2002. The 'old patients', those who being regularly treated over six months plus new patients, those who came at first time were defined. Results: The process indicators of measuring body weight, blood pressure, and blood glucose per month were executed over 93%, if being corrected with execution per visit instead of per month, and then the rates increased to over 99%. The process indicator of fundus examination was executed over 99%. The A1C and microalbuminuria were executed 82% and 89%. Due to some patients delayed the examination till next visit the corrected rate of A1C to 7month increase to 93%. There was no gender preponderance. The retinopathies by fundoscopic examination in both groups did not show any significant differences, p=0.0180 by fisher’s exact test. The diastolic blood pressure did show a significant difference for group and time effect by repeated measure of random effect model, on the other hand the systolic blood pressure was not the case in group and time effect, p=0.176. The anteprandial sugar were significant different for group and time tested by repeated measure of random effect model and the postprandial sugar did show only time by the same method. The A1C did show a significant difference in the first month and thereafter not any more significant. The average waiting time was 15±11 minutes. Conclusion: The cross sectional observation for 9 months suggested that a retrospective and prospective review of the management must be very interesting to show the effect of the management.