提升「糖尿病醫療給付改善方案」眼底檢查執行率

Diabetic retinopathy is the main cause for blindness in an adult of which the early stage is asymptomatic. Screening and prevention can reduce the rate of blindness in patients and decrease the burden on government health care. According to the quality of care indicator of Pay-for-Performance Program for Diabetes under the Taiwan Bureau of National Health Insurance, the patients should perform a funduscopic exam once per year. The implementation rate of the funduscoptic examination at the case hospital was 11% in 2008, comparing with the 63.92% quality of care indicator by the Taiwan Bureau of National Health Insurance in the same year, the rate was significantly lower. As the survey results indicated, reasons for the low funduscoptic examination implementation rate were (1) the lack of knowledge; (2) a funduscoptic exam cannot be completed during one outpatient clinic visit; and (3) the complicated procedure of a funduscoptic examination. To improve these problems, solutions adopted in this project were (1) enhancing health education regarding funduscoptic exams; (2) training professional inspectors; (3) increasing clinic hours for eye exams; (4) assisting funduscoptic examination arrangements and simplifying the funduscoptic examination process. Results obtained from the solutions, the implementation rate of the funduscoptic exam rose from 11% to 65%. The alternatives had achieved goals of the project. This can also serve as a reliable reference of problem-solving for the diabetic care professionals.