Chen Cheng-Han, Ma Sheng-Hsiang, Hu Sung-Yuan, Chang Chia-Ming, Chiang Jen-Huai, Hsieh Vivian Chia-Rong, Yen David Hung-Tsang, How Chorng-Kuang, Hsieh Ming-Shun
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
BMJ Open. 2018 Jul 12;8(7):e021382. doi: 10.1136/bmjopen-2017-021382.
The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases.
From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases.
The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes.
Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.
糖尿病共享照护计划（DSCP）是台湾的一种综合照护模式，已被证明可提高糖尿病患者的照护质量。我们旨在评估DSCP在降低传染病医院死亡率方面的疗效。
从1999年至2013年间新诊断的1662929例2型糖尿病患者中，我们选取了919例以首次因传染病住院参与DSCP的患者作为研究队列，以及9190例倾向评分匹配的未参与DSCP的2型糖尿病患者作为对照。通过DSCP队列与非DSCP队列之间的以下比较来评估DSCP的疗效：医院死亡率、住院前和住院期间的1年医疗费用，以及并发症，如接受机械通气和入住重症监护病房。通过逻辑回归计算DSCP参与者医院死亡率的比值比（OR）。进行进一步的分层分析，以检查哪一组2型糖尿病患者在传染病住院期间从DSCP中获益最大。
DSCP队列的医院死亡率低于非DSCP参与者（2.18%对4.82%，p<0.001）。DSCP队列的住院总医疗费用低于非DSCP队列（新台币72454±30429对新台币86385±29350）（p=0.006）。在逻辑回归模型中，DSCP参与者的医院死亡率调整后OR显著降低（调整后OR=0.42，95%CI 0.26至0.66，p=0.0002）。DSCP的疗效在男性2型糖尿病患者和低收入患者中更为显著。
参与DSCP与传染病医院死亡风险较低相关。
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