Shin Soon Ae, Kim Hyeongsu, Lee Kunsei, Lin Vivian, Liu George, Shin Eunyoung
Bigdata Steering Department, National Health Insurance Service, Seoul, Korea.
Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea.
Yonsei Med J. 2015 Jan;56(1):244-52. doi: 10.3349/ymj.2015.56.1.244.
This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design.
The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007.
The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention.
This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.
本研究旨在采用前后对比设计评估一项针对糖尿病患者的病例管理计划的效果。
研究人群包括2006年在韩国全国范围内抽样的6007名接受病例管理干预的糖尿病患者。在干预前后，研究人群回答了有关糖尿病知识、自我管理能力和健康行为的问题。还计算了体重指数（BMI）。从2005年至2007年的健康保险理赔数据中提取糖尿病的医疗服务利用情况。
病例管理计划显著提高了研究人群的糖尿病知识以及营养自我管理、血糖监测、足部和口腔护理及用药能力。该计划还显著改变了研究人群在吸烟、饮酒和运动方面的健康行为，且BMI受到了积极影响。在服务过度的亚组中，干预后咨询次数显著减少（均值 = 7.0；标准差 = 19.5）。相反，在服务不足的亚组中，干预后咨询次数（均值 = 3.2；标准差 = 7.9）和处方药天数（均值 = 66.4；标准差 = 120.3）显著增加。
本研究表明，病例管理计划使研究人群在知识、自我管理能力、健康行为和医疗保健利用方面得到改善。未来的研究有必要通过使用对照组来评估医疗保健使用的适当性和临床结果，以确定该病例管理计划的直接效果。
