992 2 1 1 2 2 2 IDS 96 IDS IDS IDS IDS 596 1 198 12 31699 1 199 9 30 250401 272/274 B070.2 070.3C070.51 070.54 070.415 277HbA1C39~55%2 60HbA1c<7%46~63 40 893 2 60 1 74 2 3 <7mg/dl43~50406 40% 46.4% 45.5% IDS IDS IDS 54 89 8 1 Integrated Delivery System IDS IDS 15,000 88 65 1 2 99 9 1 99 9 28 545 1
2 2010 Vol.2 No.2 9.1% 400 3600 3 50 10 3 IDS 9413,445 75% 5,842 33.5% 6,000 IDS 1 98% IDS IDS [1,2] IDS 65 [1] [3-7] 3 [8] 1 IDS 97IDS 5 5 965 IDS
992 2 3 IDS IDS IDS 96 15 IDS 1 250 401 272 274B070.2 070.3C 070.51 070.54 070.41 IDS 2 2 20 99 16 IDS i-care http://www.i-care.com.tw/pch_ Login.aspxi-care IDS 2 5 USB i-care 1IDS 1. HbA1C HbA1C 7 60 /40 2. 3 3. CHO TG HDL LDL 130 85 CHO 200 TG 200 60 /40 60 /40 4. UA UA 7mg/dl 60 /40 5.B GOT GPT AFP 6.C GOT GPT AFP GOT 40 GPT 40 GOT 40 GPT 40 60 /--- 60 /---
4 2010 Vol.2 No.2 2 IDS i-care 3 i-care
992 2 5 4 i-care 5 i-care
6 2010 Vol.2 No.2 6 IDS 596 1 198 12 31 699 1 199 9 30 5IDS 96 202 98 2867 5 IDS 6
992 2 7 7IDS 277 2HbA1C 39~55%2 60 HbA1c<7%46~63 40 893 3 2 60 1 74 2 3 <7mg/dl43~50 40 99i-care6 IDS 3004 548 2514B CIDS 300 7 BC 99 9 40% 46.4% 45.5% 6 IDS 4 IDS IDS IDS IDS
8 2010 Vol.2 No.2 25 IDSHbA1c HbA1c7 HbA1c 96 97 98 38 33 87%* 28 22 79%* 56 43 77%* 112 64 57%* 110 34 31% 128 55 43% 9 0 0% 9 0 0% 8 3 38% 36 11 31% 34 15 44% 40 18 45% 45 0 0% 195 108 55% 181 71 39% 277 119 43% HbA1c 96 97 98 18 15 55%* 17 5 77%* 23 20 53%* 29 35 43%* 19 15 56%* 28 27 51%* 0 0 0% 0 0 0% 3 0 100%* 3 8 27% 9 6 60%* 10 8 56%* 0 0 0% 50 58 46% 45 26 63%* 64 55 54%* * 35 IDS7mg/dl 96 97 98 23 10 43% 39 25 64%* 94 58 62%* 146 73 50% 140 34 26% 116 47 41% 0 0 0% 0 0 0% 4 0 0% 465 389 84%* 453 268 59% 566 376 66%* 113 41 36% 634 472 74%* 632 330 52% 893 522 58% 96 97 98 3 7 30% 18 7 72%* 29 29 50%* 43 30 59%* 27 10 73%* 34 13 72%* 0 0 0% 0 0 0% 0 0 0%* 159 230 40% 121 147 45%* 163 213 43%* 23 18 56%* 205 267 43%* 166 164 50%* 249 273 48%* *
992 2 9 4 99 6 IDS IDS 99/5 99/6 99/7 99/8 11 50 43 75 105 96 110 100 0 4 1 2 50 19 56 29 0 99 121 95 166 268 331 301 5 99 6 IDS IDS B C 115 45 19 5 87 38 192 53 12 3 65 36 5 2 0 0 0 0 67 13 0 0 68 21 213 54 0 0 87 33 592 167 31 8 307 128 48% 14% 3% 1% 25% 10% 6 99 6 IDS99 1 19 30 B C 130 85 7% GOT 40 GPT 40 GOT 40 GPT 40 UA 7 CHO 200 TG 200 17.6 36.4 72.7 0 18.2 37 46.4* 34.1 31.8 27.3 100 18.2 37 25 3.3 4.5 0 0 0 0 0 14.3 18.2 0 0 45.5* 22.2 21.4 30.8 9.1 0 0 18.2 3.7 7.1 * %
10 2010 Vol.2 No.2 [9] IDS [10] IDS 4 HbA1c 4 32774 167 1 3 [11] IDS 69.3% 61.3% 46.7% 22.8% 15.2% [12] i-care IDS 4 IDS IDS IDS IDS IDS IDS 1. 2004 2. 2002 3. 2006;3(3):248-259 4. : 2002;3(2):35-48 5.
992 2 11 2004;5(2):222-242 6. 2007 7. 2009 8. 2006 9. The Effects of Providers' Perception of the Diabetes Disease Management Program on Their Participation 2008;18(2):82-99 10. 2010 11. 2008 12. 2004;24:53-78
12 Quality management in rual health care- experience from the Jen- Ai integrated delivery service (IDS) plan Chih-Kuei Lee 1, Mei-Fang Pan 2, Pan-yu Tseng 2, Hsin-Hui Tserg 2 Studies had shown that the Integrated Delivery Service (IDS) plans by the National Health Insurance Bureau were effective in enhancing convenience, accessibility and comprehensiveness of health care to people in rural areas in Taiwan. Yet most IDS plans do not incorporate disease management programs for chronic diseases due to lack of manpower and professionals. Puli Christian Hospital (PCH) IDS Jen-Ai plan started disease management for chronic care in 2007, and monitored a set of quality indicators in the IDS annual audit process. This article introduced the processes and outcomes of disease management in IDS Jen-Ai plan. We analyzed all disease management cases recruited from January 1, 2007 to September 30, 2010. The scope of disease management includes diabetes, hypertension, hyperlipidemia, hyperuricemia, hepatitis B, and hepatitis C. In the first phase (year 1 to year 3), up to 277 diabetic subjects were recruited. HbA1c check up rates were 39-55% (The goal is 60% of subjects receiving HbA1c tests 2 times per year). The glucose control rates (HbA1c<7%) were between 46-63 Up to 893 hyperuricemic subjects were recruited. Uric acid check up rate was 74% in the first year (The goal is 60% of subjects receiving uric acid tests 2 times per year). The uric acid control rates (<7 mg/dl) were between 43-50In the second phase (year 4), most indicators for disease control were below the set standards and varied greatly among IDS health care organizations. With proper communication and information systems, disease management can reveal the accountability of an IDS plan in rural mountain areas. However, factors associated with provider participation and trend of unfavorable outcomes over time should be explored. Key words: disease management, case management, IDS, rural area Department of Community Health 1, Mountain Medical 2, Puli Christian Hospital Received: September 1, 2010; Accepted: September 30, 2010 Corresponding author: Mei-Fang Pan Contact address:department of Mountain Medical, Puli Christian Hospital, Puli, Taiwan