title: Long-term glycemic control by a diabetes case-management program and the challenges of diabetes care in Taiwan.
abstract: OBJECTIVE
  This study aimed to evaluate the long-term effects on glycemic control of a diabetes care program focusing on case management and to discuss challenges in the quality of diabetes care in Taiwan.
  
  
  METHODS
  We randomized 1,060 study subjects recruited from the Diabetes Management through an Integrated Delivery System project in 2003-2005 into intervention (n = 789 from 27 clinics) and control (n = 271 from 7 clinics) groups. The quarterly self-care and nutrition-education program in the intervention group was delivered by case managers, and standard care was provided to the control group. The intervention program was conducted during 2003-2007. A multivariate mixed model analysis was used to assess the 3.5-year intervention effects on glycemic control.
  
  
  RESULTS
  Glycated hemoglobin (HbA1c) level in the intervention group (especially for those with a baseline HbA1c level of 7-9% and >9%) was significantly lower than that in the control group 6 months after recruitment and remained lower through the subsequent three intervention years.
  
  
  CONCLUSIONS
  The current findings provide evidence that case management provided in the pay-for-performance (P4P) diabetes care program in Taiwan was effective at improving glycemic control for at least 3 years. However, previous research indicated poverty is associated with not only higher diabetes incidence but also inequality of diabetes care in Taiwan despite universal health coverage. Those with a more severe condition were less likely to be enrolled in the P4P diabetes care program. Additional cost-effectiveness studies and more health policy reforms are needed to optimize diabetes care in Taiwan.
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan. Electronic address: cch@nhri.org.tw.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Taipei Jen-Chi Relief Institution, Taipei, Taiwan; Formosan Diabetes Care Foundation, Taipei, Taiwan.
authors.forename: Tong-Yuan
authors.initials: TY
authors.lastname: Tai
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D019090:Case Management; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D013624:Taiwan; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Case management; Diabetes mellitus; Glycemic control; Socioeconomic disparity