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題名：參與論質計酬方案對接受冠狀動脈繞道手術之糖尿病病人之預後影響
書刊名：臺灣公共衛生雜誌
作者：鍾文誠／吳肖琪／李曉伶
作者(外文)：Chong, Wen-cheng／Wu, Shiao-chi／Lee, Hsiao-ling
出版日期：2013
卷期：32:6
頁次：頁615-625
主題關鍵詞：冠狀動脈繞道手術；糖尿病；糖尿病論質計酬方案；Coronary artery bypass graft surgery；Diabetes；Pay for performance program
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  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0)
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  • 共同引用共同引用:6
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目標：探討接受冠狀動脈繞道手術之糖尿病病人參與論質計酬方案對術後感染及死亡情形之影響。方法：採用回溯性世代研究法，以全民健保2009－2010年間接受冠狀動脈繞道手術之成年糖尿病病人為研究對象。利用趨勢檢定參與糖尿病論質計酬方案程度對接受冠狀動脈繞道手術之糖尿病病人之預後關係。結果：未參與糖尿病論質計酬方案者佔80.92%、未連續參與者佔13.55%、連續參與者僅佔5.53%；術後30、90日感染情形，皆以連續參與組最低，分別為3.00%及3.06%；未參與組最高，為6.89%及8.88%；校正後的OR值分別為0.92及0.33。術後30、90日死亡情形，亦是連續參與組最低，分別為1.96%及3.92%；未參與組最高，為5.49%及9.24%；校正後的OR值分別為0.52及0.44，趨勢檢定達顯著差異。結論：參與糖尿病論質計酬方案之病人在接受冠狀動脈繞道手術後之感染及死亡風險皆較未參與者低，可作為衛生主管機關加強鼓勵糖尿病病人參與論質計酬方案之參考，同時鼓勵醫療院所提升糖尿病論質計酬方案之涵蓋率，以減少日後糖尿病病人之術後併發症的發生。
Objectives: The aim of this study was to explore the impact of a pay for performance program on the outcome after coronary artery bypass graft surgery (CABG) in diabetic patients. Methods: This study employed a retrospective cohort study design, and the study subjects were adult diabetic patients who underwent CABG during 2009-2010. A trend test was used to evaluate the relationship between participation in the pay for performance program and the outcome. Results: Among the diabetic patients undergoing CABG, those who did not participate in the pay for performance program accounted for 80.92%, those with non-continuous participation accounted for 13.55%, and those with continuous participation accounted for 5.53%. Infection rates within 30 and 90 days after operation were lowest in the continuous participation group (3.00% and 3.06% respectively) compared to 6.89% and 8.88% in the non-participation group. The adjusted ORs were 0.92 and 0.33. The trend test showed significant differences. Death rates within 30 and 90 days after operation were also lowest in the continuous participation group (1.96% and 3.92% respectively) compared to 5.49% and 9.24% in the non-participation group. The adjusted ORs were 0.52 and 0.44. Conclusions: Participation in a pay for performance program lowered the postoperative infection and death risks for diabetic patients. Health authorities should make greater efforts to encourage diabetic patients to participate in a pay for performance program, and also encourage medical institutions to improve coverage for pay for performance programs. For diabetic patients in the program, medical institutions should follow-up and guide patients to receive continuous care in order to reduce or delay the occurrence of comorbid conditions and postoperative complications.
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17.許碧峰(20090200)。冠狀動脈繞道手術量與療效關係之實證研究。臺灣公共衛生雜誌，28(1)，1-9。new window  延伸查詢new window
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22.Miskulin, D. C.、Bragg-Gresham, J.、Gillepsie, B. W.(2009)。Key comorbid conditions that are predictive of survival among hemodialysis patients。Clin J Am Soc Nephrol，4，1818-1826。  new window
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研究報告
1.衛生福利部中央健康保險署(2010)。全民健康保險論質計酬醫療給付改善方案執行情形與檢討報告。台北：衛生福利部中央健康保險署。  延伸查詢new window
2.李玉春(2006)。台灣地區醫療院所糖尿病照護品質之監控及比較研究 (計畫編號：DOH93-HP-1103)。台北：衛生福利部國民健康署。  延伸查詢new window
3.賴美淑(2011)。利用健保及其他資料庫建立院內感染品質指標 (計畫編號：DOH100-DC-1020)。台北：衛生福利部疾病管制署。  延伸查詢new window
4.鎮明常(2007)。以各機構及病人角度調查病人安全政策的推動成效 (計畫編號：DOH96-TD-M-113-028)。苗栗：國家衛生研究院。  延伸查詢new window
學位論文
1.葉憲宗(2010)。第二型糖尿病人施行塗藥血管支架手術後服用Thiazolidinediones對其預後之影響(碩士論文)。國立陽明大學，臺北。  延伸查詢new window
圖書
1.Soltoski, P. R.、Karamanoukian, H. L.、Salerno, T. A.(2004)。Cardiac Surgery Secrets。Philadelphia：Hanley & Belfus。  new window
2.Jowett, N. I.、Thompson, D. R.(2007)。Comprehensive Coronary Care。Edinburgh, UK：Elsevier。  new window
 
 
 
 
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