Contributions of patient characteristics and organizational factors to patient outcomes of diabetes care in Hualien, Taiwan

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Chang, Shu-chuan

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This cross-sectional study measured quality of diabetes care and explored the contributions of patient and organizational factors to patient outcomes of diabetes care in Hualien, Taiwan. Donabedian’s structure-process-outcome framework was applied to examine the system of health care in Hualien County with respect to the quality and outcomes related to patients with diabetes. One hundred forty participants were randomly selected from the list of individuals with diabetes who were seen at the medical center in Hualien during 2000 and 2001. Data collection included administering questionnaires through the mail or by direct interview in early 2003 and reviewing medical records over the course of the year 2002. Patient characteristics (gender, age, education, ethnicity, occupation, length of time since diagnosis, pattern of diabetes treatment, and comorbidity) and organizational factors in terms of structure (institute characteristics and physician specialty) and the care process (patient-physician relationships, organizational collaboration, and preventive monitoring and diabetes education) were examined in light of their contributions to patient outcomes: glycemic control, adherence to self-care regimen, and quality of care . Findings included: three patient outcomes of diabetes care, diabetes professional performance, and contributions of patient and organizational factors to the outcomes. The average A1C level was 8.27%; patient adherence to self-care regimen was moderate. Scores of patient perception of quality of life were lower in physical and psychological domains but higher in social relations and environmental domains than scores in other studies. Data about professional performance showed a need to improve preventive care for patients. Regression procedures highlighted the contributions of patient and organizational factors to patient outcomes. The structure of care (institute characteristics, and physician specialty) accounted for 8.1 % of the variation in glycemic control. Patient characteristics (level of education and ethnicity) and organizational factors (structure and process, health institute characteristics and patient-professional relationships) accounted for 23.0% of the variance in adherence to self-care. Patient characteristics (patient ethnicity and comorbidity) and interpersonal processes of care (patient-professional relationships) accounted for 31.1% of the variance in perceptions of quality of life.