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团队式照护可提升糖尿病照护品质—以家庭医学整合照护计划为例(台湾)。

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan.

机构信息

Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan.

Taiwan Medical Association, Taipei, Taiwan.

出版信息

BMC Fam Pract. 2020 Oct 15;21(1):209. doi: 10.1186/s12875-020-01284-w.

Abstract

BACKGROUND

The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care.

METHODS

This population-based cohort study used Taiwan's National Health Insurance Administration data on FPICP (fiscal year 2015-2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE).

RESULTS

The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE.

CONCLUSION

Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.

摘要

背景

家庭医学整合照护计划(FPICP)是台湾于 2003 年发起的一个基于团队的项目。本研究调查了 FPICP 对糖尿病护理质量的影响。

方法

本基于人群的队列研究使用了台湾全民健康保险管理局关于 FPICP 的数据(2015-2016 财年,随访时间为一年)。参与者包括初级保健诊所中年龄≥30 岁的糖尿病患者。我们使用条件逻辑回归模型对患者特征和每年的糖尿病检查进行建模,并将 FPICP 参与者与非参与者进行比较。主要结局指标包括完成年度糖尿病检查,包括糖化血红蛋白(A1c)、低密度脂蛋白(LDL)、尿微量白蛋白(MAU)、常规尿检(UR)和眼底检查(FE)。

结果

样本包括 298208 名 FPICP 参与者和 478778 名非参与者。经过 1:1 倾向评分匹配后,FPICP 参与者和非参与者的检查完成率分别为 A1c 为 94.4%比 93.6%,LDL 为 84.2%比 83.8%,MAU 为 61.9%比 60.1%,UR 为 59.2%比 58.0%,FE 为 30.1%比 32.4%。

结论

我们的研究结果表明,像 FPICP 这样的计划可以通过定期检查 A1c、LDL、MAU 和 UR 来提高糖尿病护理质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da1/7565358/8a3c0073f223/12875_2020_1284_Fig1_HTML.jpg

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