The effectiveness of hospital-based diabetes case management: an example from a northern Taiwan regional hospital.
The aim of this study was to design, implement and evaluate disease outcomes at a regional hospital- based case management program of care for patients with type 2 diabetes. A medical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p< .0001), fasting glucose (p< .01) and triglycerides (p< .05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.
Chang
Huan-Cheng
HC
Division Community Medicine Department, Li Shin Hospital.
Chang
Yue-Cune
YC
Lee
Su-Mei
SM
Chen
Mei-Fang
MF
Huang
Mei-Ching
MC
Peng
Chin-Lin
CL
Yan
Ching-Yun
CY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000553:Ambulatory Care / Q000458:organization & administration* / Q000523:psychology; D019090:Case Management / Q000458:organization & administration*; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000517:prevention & control* / Q000523:psychology; D003927:Diet, Diabetic / Q000523:psychology; D015444:Exercise / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D012648:Self Care / Q000523:psychology; D013624:Taiwan
D006442:Glycated Hemoglobin