| Objective:To evaluate the outcomes of intensive diabetes training on doctors in the community health service center (CHC) and make short-term Cost-effectiveness Analysis via prospective cohort study. Use Markov model to simulate long-term effectiveness and make economical evaluation, which aims to provide evidence advice to policy maker.Materials and Methods:A amount of DM patients were draw from both communities whose doctors were under intervention and not. Methods to collect materials combination of questionnaire interview, blood test and research review. The demographic characteristics, the frequency of dynamic blood sugar monitoring, healthy behavior, blood biochemical indexes, complication, outpatient visit in recent three month, inpatient visit in recent one year, satisfaction on CHC, cost of intervention and materials refer to Markov model were collected by these methods. Descriptive analysis was used to represent the baseline of both cohort patients; the short-term effect of intervention was evaluated by comparing the change of outcome indexes; use research review to construct Markov diabetes model and define parameters and transition probability; the structure and amount of diabetes cost was calculated by cost analyses; cost-effectiveness analysis was used to make economical evaluation.Results:1.407 patients from both group (interventional group 195, control group 212) were enrolled in this research, the average age is 71. No statistically difference has been found between both groups on demographic characteristics, baseline blood biochemical indexes and complication.2. Here is changes of behavior outcomes in interventional group versus control group after one year's intervention:the ratio of people who test blood sugar at least once in one week raised by 14.2%, the average days of following healthy plan in one week raised 1.2, the average days of taking at least 5 time vegetable or fruit in one week raised 0.6, the average days of taking high-fat food in one week fell 0.5, the average days of doing 30 minute exercise per day in one week raised 0.3, the average days of checking feet in on week raised 0.5.3. Here is changes of blood biochemical indexes in interventional group versus control group after one year's intervention:fasting Blood-glucose fell 0.90 mmol/l, glycosylated hemoglobin fell 1.45%, total cholesterol fell 0.40 mmol/l, Triglyceride fell 0.38 mmol/1, low-density lipoprotein fell 0.41 mmol/1.4. The incremental ratio of people who test blood sugar at least once in one week was 14.2%, cost effectiveness ratio is 3924 Yuan per percent; the incremental average days of following healthy plan in one week was 1.2, cost effectiveness ratio is 46018 Yuan per day; the incremental value of fasting Blood-glucose was 0.90mol/l, cost effectiveness ratio is 61356 Yuan per 1 mmol/l; the incremental value of glycosylated hemoglobin was 1.45%, cost effectiveness ratio is 41209 Yuan per percent.5. Markov model has computed the final number of people who has complication or not in a defining cohort which starts with 10000 DM patient after 10 year's intervention. Result shows that:in the interventional group,the number of people without complication has fell 345, the number of people with complication has raised 319,26 death happened in ten years; in the control group, the number of people without complication has fell 958, the number of people with complication has raised 931,27 death happened in ten years. the incremental number of people without complication in interventional group has reduced 612 complication versus control group, cost effectiveness ratio is 39500 Yuan per people.Conclusion:The intervention of intensive intensive diabetes training on doctors in CHC has motivated the dynamic blood sugar monitoring, improved the healthy behavior. Long-term intervention can slow down the new appearance of new complication, but it can not impact the death of diabetes. |
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