Effectiveness Of Information System Based Community-Hospital-Integrated Diabetes Management

BackgroundThe derm diabtes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with distrubances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Latest epidemiology study shows that there are now over 92 million diabetic patients in China's adult population, with a prevalence of 9.7%(11.4% in residents of urban area and 8.2% in residents of rural area), and 150 million are currently in the prophase stage of diabetes.The tertiary prevention of diabetes is a guideline designed for different stages in the development of diabetes mellitus, including keeping diabetes from happening in general public, keeping diabetic complications especially chronic complications from happening in diabetes patients, and reducing deformity and death in diabetes patients. According to Disease Management Theory, the term disease management refers to take different approaches in different stages of disease, in order to control the cost of healthcare. Therefore, the tertiary prevention of diabtes can be viewed as the guidelines of diabetes management.The major forms of diabetes management include hospital-based management, community-based management and community-hospital-integrated management. Currently, community-hospital-integrated management is the main direction of diabetes management in China.Under the background of China's Health Care System Reform, the current national strategy of prevention and control of diabetes mellitus in China is to put emphasis on the prevention and control of the high-risk population of diabetes, while continuing and strengthening diabetes-related health education and health promotion for the general public. The National Basic Public Health Service Program included diabetes management as one of the nine basic public health service item, and till the end of 2010, there has been over 9 million registed diabetic patients nationalwide.Objective:(1) Explore the characteristics of information system based community-hospital-integrated diabetes management, and the opportunities and threats in current environment for it. (2) Take Minghang Distric in Shanghai as an example, to explore the effectiveness of information system based community-hospital-integrated diabetes management, and the influencing factors of the effectiveness of information system based community-hospital-integrated diabetes management. (3) Propoes policy suggestions for diabetes management in the future.Results:(1)The characteristics of diabetes management in Minghang District includes: information system works through out the whole process of diabetes management; community healthcare workers, including physicians, nurses and public health workers work as the main force of diabetes management, and perform a dynamic care for diabetic patients; adopting a hierarchical-management scheme and apply different packages according to patients'bloodsugar level; applying different follow-up visit forms according to patients'situation; emphasizing self-management.(2)Strength of information system based community-hospital-integrated diabetes management includes:help to increase efficiency of community healthcare; making individualized management possible; realize a flawless linkage between healthcare services among different institutions, increase the efficiency in utilizing health resources and lighten the economic burden of diabetic patients; improve management of community health service; and making the assessment of diabetes management more convenient. Weakness of information system based community-hospital-integrated diabetes management includes:requires large amout of input in terms of fund and human resources; lack of guidelines, standards, and surveillance of certain parts of the procedure. Opportunites under current circumstances include:the rapid development of information techonology; polical support within the medical reform and the Twelve Five-Year plan; rising health consciousness of general public. Threats under current circumstances include:internet safety issues; primary-level health workers'deficiency in getting information through network; the competition in healthcare market and the influence of patients'choice had on the Two-way Referral process.(3)Currently, female patients account for 56.15% in diabetic population in Minghang district; the average age of the population is 64.98±11.14 years old, and patients who are up to or above 50 years old account for 92.09% in the population. As to the type of disease, type 2 diabetes accounts for 91.83% of total headcounts, while IGT and IFG takes up 5.07% and 1.83% respectively. The average course of disease is 7.27±6.06 years.(4) Right now, community clinics are the major platform of screening for diabeteic patients since the patients who are diagnosed in community clinics account for 91.92% of all newly diagnosed. The percentage of diabetic patients whose bloodsugar level is considered to be ideal, fair, and poor is 36.12%,32.53%and 31.34% respectively. Diabetic patients in Minghang district score high in terms of self-management except for patients who rarely do any exercises accounts for 31.72%. 92.91% of type 1 diabetes patients are taking medications; the percentive of patients who are using inslin is 36.32%.85.07% of type 2 diabetes patients are taking medication, and the most popularly used medicine is sulfonylureas.16.8% of IGT patients and 23.9% of IFG patients are taking medication.(5) During the study period,2.95% IGT patients and 2.34% of IFG patients turned into diabetes patient. The percentage of patients with an ideal blood sugar rose from 20.59% to 28.10%. The percentage of patients who would monitor bloodsugar regularly rose from 77.90% to 83.27%. The percentage of patients who don't do any exercise reduced from 46.24% to 45.31%. The percentage of patients who monitor diet completely according to doctor's suggestion rose from 80.83% to 82.31%.(6) Regression analysis shows that over 50 years old, take heavy exercises, attend group follow-ups or door-to-door follow-ups are the factors that are good for maintaining an ideal blood sugar level; while a couse of disease of over 7 years, overweight or obesity are bad for the purpose. A couse of disease of over 1 year, attending group follow-ups and do not take medication are the factors which are good for IGT patients regain normal status in terms of glycometabolism.Conclusion:(1) Information system based community-hospital-integrated diabetes management has significant effectiveness. (2) Information system strengthens the performance of community healthcare insititution in screening for diabetes patiens. (3) There are still large amount of potential diabetes patients in Minghang district that have not been diagnosed yet. (4) There are some deficiencies in diabetes management program of Minghang disctrict in terms of screening for diabetic complications. (6) Effectiveness of group follow-up and door-to-door follow-up are superior to that of out-patient follow-up visits.Suggestions of Policy:(1) Fully utilize the political support to strengthen the informationization in health sector and to improve healthcarae personnel training procedure. (2) Correcting the performance of diabetes management to the evaluation performance of healthcare institution and health workers, in order to provide incentives for different health service provider and health worker to engage in diabetes management. (3) Rectify the deficiencies in the design of diabetes management program, and constitute diabetes management related guideline, procedure, and standard. (4) Put more emphasis on the issue of rational drug use of diabetes patients, and establish necessary surveillance scheme. (5) Make full use of the rising health consciousness of the public and continue to strengthen diabetes related health education.