Weng Hui-Ching
Health Management Department, I-Shou University, #1 Section 1 Hsueh-Cheng Road, Ta-Hsu Hsiang, Kaohsiung County, Taiwan 480.
Dis Manag. 2005 Feb;8(1):48-58. doi: 10.1089/dis.2005.8.48.
In response to the high prevalence rates, mortality rates, and rising medical cost of asthma, the Bureau of National Health Insurance (BNHI) initiated a Healthcare Quality Improvement Program (HQIP) for people with asthma. The aim of this study was to investigate a preliminary analysis of the impact of a government-sponsored, outpatient-based disease management programs for people with asthma on the economic outcomes, the physician's and the patient's satisfaction. Using a retrospective design, a 1:4 (intervention vs. control group) matched cohort study design was used. Comparison of 1-year pre/post tests of utilizations of healthcare resources were conducted for 854 already diagnosed cases of patients with asthma. Comparison of independent tests between the intervention group and control group were performed for already diagnosed cases (n = 854) and newly-diagnosed cases (n = 231). Valid surveys were received from 212 physicians who participated the program, for a response rate of 46.0%, and 642 patients who enrolled in the program, for a response rate of 27.70%. Results indicated that the intervention group of already diagnosed cases had 39.94% fewer ED visits, 46.31% fewer inpatient visits, and 51.74% shorter length of stay, at a significant level. Though the HQIP program for people with asthma appeared to reduce medical care resource utilization for the intervention group, the control groups showed similar reductions but in different magnitude. For the newly diagnosed group, the intervention group had 197.43% more outpatient visits and 61.19% fewer ED visits of than those of the control group at a significant level. A majority of physicians (70%-85%) had positive opinions toward the HQIP program, but they admitted that the HQIP program prolonged the consultation time in outpatient visits (79.1%), and only 29.7% physicians did not feel interfered with while carrying out the HQIP. More than 80% of the patients showed positive feedback to the HQIP. The majority of the patients substantially adhered to physicians' suggestions, and had more accurate knowledge of and better self-care skills concerning asthma. These results have significance for the design of future programs aimed at improving the care of people with asthma and other chronic diseases in BNHI, Taiwan.
鉴于哮喘的高患病率、死亡率以及不断攀升的医疗费用，国民健康保险局（BNHI）启动了一项针对哮喘患者的医疗质量改进计划（HQIP）。本研究旨在对一项由政府资助、基于门诊的哮喘患者疾病管理计划在经济成果、医生及患者满意度方面的影响进行初步分析。采用回顾性设计，使用了1:4（干预组与对照组）匹配队列研究设计。对854例已确诊的哮喘患者进行了医疗资源利用的1年前后测试比较。对已确诊病例（n = 854）和新确诊病例（n = 231）在干预组和对照组之间进行了独立测试比较。从参与该计划的212名医生那里收到了有效调查问卷，回复率为46.0%，从参与该计划的642名患者那里收到了有效调查问卷，回复率为27.70%。结果表明，已确诊病例的干预组急诊就诊次数减少了39.94%，住院就诊次数减少了46.31%，住院时间缩短了51.74%，达到显著水平。尽管针对哮喘患者的HQIP计划似乎减少了干预组的医疗资源利用，但对照组也有类似减少，只是幅度不同。对于新确诊组，干预组的门诊就诊次数比对照组多197.43%，急诊就诊次数比对照组少61.19%，达到显著水平。大多数医生（70%-85%）对HQIP计划持积极态度，但他们承认HQIP计划延长了门诊会诊时间（79.1%），只有29.7%的医生在实施HQIP时没有感到受到干扰。超过80%的患者对HQIP给予了积极反馈。大多数患者基本遵循医生的建议，对哮喘有更准确的认识和更好的自我护理技能。这些结果对于未来旨在改善台湾BNHI中哮喘患者及其他慢性病患者护理的计划设计具有重要意义。
