Exploring Factors Affecting Physicians’ Intension to se the National Health Insurance’s VPN Information System: Using Diabetes Mellitus Care as an Example
Date Issued
2008
Date
2008
Author(s)
Hsu, Pei-Jung
Abstract
Information feedback involves giving physicians information about how their practices or patient outcomes compare with those of other physicians or with an external standard(Eisenberg, 1993).It is also a reporting on past patient care activities future clinical decisions(Balas et al., 1996).The Bureau of National Health Insurance use VPN information system as a medium to feedback the quality indicator performance to medical institution since 2005. The objectives of this study are to research how the physician’s participation in diabetes mellitus disease management program impacts their use of VPN information system inquiring DM indicators, and to explore the influence of indicators feedback on physician’s practice. There are two frameworks in the study. The first one is the factors affecting physician’s using of VPN. The independent variable is the extent of participation in DM disease management program, the dependent variable is the situation of using VPN, and the control variables are demographic characteristics, working condition, participation of family physician system, and reception of DM report card. Then put the physicians who had used the VPN for inquiring DM indicators performance to the second framework for analysis. The second framework derived from the Theory of Planned Behavior (Ajzen, 1991), exploring the relevant factors influencing physician’s intention to change practice according to the DM indicators feedback. The population of this study is 1211 clinics which care the diabetes patients under the Bureau of National Health Insurance Taipei Branch’s authority during July to September 2007. This study used a structured self-evaluated questionnaire to collect data. The survey subjects were 510 clinic presidents. There are 151 efficient returned questionnaires, and the response rate is 30%. In the first research framework, Chi-square test and Fisher Exact test have been used to examine the correlation between dependent and independent variables. Then Multinomial logistic regression analysis has been used to exam the hypotheses. In the second research framework, Kruskal-Wallis and Spearman rank-correlation analysis have been used to explore the correlation between the variables. The main findings of this study are as follows:.There are 15.2% of respondents knew the VPN and also inquired the implementation rate of DM indicators, 60.9% knew the VPN but didn’t inquire the DM indicators performance, and 23.8% didn’t know the VPN. .The participation of diabetes mellitus disease management program and family doctor system, the reception of diabetes mellitus report card, and high frequency of admission influence the physician taking positive action to use VPN to the DM indicator information..Physician’s rate of diabetes patients in the DM disease management program become a significant factor for inquiring DM indicators information on VPN when it is over 50%..Among the 23 physicians who use the VPN to inquire the implementation rate of DM indicators, there are 86.9% tend to enhance patient’s blood tests, 91.3% tend to take the indicators as proper measurements of diabetes care quality, 82.6% tend to consider the outcome of indicators could reflect their real practice situation. According to the result of correlation analysis, the more positive the physician’s attitude toward the DM indicators, the more they enhance the implementation rate of patients’ blood tests. According to the study results, some suggestions are given to Bureau of National Health Insurance Taipei Branch: .For the physicians don’t know VPN, enhancing the visibility and utilization of VPN information system by increasing policy advocacy; for the ones already know VPN, reducing physician’s phobia about needing to sign personal data in using the Web service by encouraging and releasing incentives..Pay attention to the physician’s multiple drivers of using VPN to strengthen the effect of information feedback to physician’s practice..Continuously put emphasis on the validity of DM indicators information could conduce to physician’s trust on the feedback. It is the essential elements which contribute to the quality of diabetes care.
Subjects
Information Feedback
Physician Profiling
Diabetes Mellitus Disease Management Program
Physician''s Behavior
The Theory of Planned Behavior
SDGs
Type
thesis
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