Ci-Yong Syu’s research while affiliated with National Taiwan University and other places

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Publications (3)


Professional accountability for diabetes care in Taiwan
  • Article

March 2006

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54 Reads

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21 Citations

Diabetes Research and Clinical Practice

Fen-Yu Tseng

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Mei-Shu Lai

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Ci-Yong Syu

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This study examined the performance of diabetes care measures in Taiwan and evaluated the influencing factors for professional accountability. We analyzed the year 2001 claims data from National Health Insurance (NHI) program in Taipei Branch. Professional accountability for diabetes care was measured by the adherence for laboratory monitor, either from patient- or hospital-viewpoint. Identifying the major care unit for each patient, a multiple logistic regression model was used to further assess the mixed effects of patient and hospital characteristics. The percentage of patients ever received measures in the year for plasma glucose, A(1C), urinalysis, renal function test, lipid profile, liver function test, and eye ground was 76.3, 42.7, 40.2, 59.7, 59.2, 53.2, and 16.8% respectively. About 19.2% patients never received any one of the measures. Patients with hypoglycemic, anti-hypertensive or anti-hyperlipidemic agents, hospitalization, emergency service visit and frequent visits were more likely to receive exams. Hospitals with different levels, ownerships, locales or qualifications as diabetes care institutions presented different accountability for diabetes care measures. After regression, counts of visits and levels of hospitals had persistently effects on all the measures. Our analysis revealed sub-optimal diabetes care in Taiwan and concluded the importance of enhancing care quality from primary settings.


Accuracy of Diabetes Diagnosis in Health Insurance Claims Data in Taiwan

April 2005

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271 Reads

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494 Citations

Journal of the Formosan Medical Association

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Mei-Shu Lai

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Ci-Yong Syu

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[...]

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Fen-Yu Tseng

There are limited data from Taiwan about the accuracy of National Health Insurance (NHI) claims data. This study assessed the accuracy of NHI claims data for diabetes and its associated factors. Insurance claims data for patients with a diagnosis of diabetes were extracted from the records of the Bureau of National Health Insurance, including detailed files of the outpatient, emergency, inpatient and pharmacy treatment records from January 1, 2000 to December 31, 2000. A stratified, 2-staged, probability proportional to size and equal probability method was used to sample 9000 diabetes patients. The accuracy of the diabetes diagnosis was assessed based on patient responses to questionnaire items. Subjects with negative or uncertain questionnaire answers who had hypoglycemic agents in pharmacy claims data were also classified as diabetic. A total of 1350 questionnaires were returned and an accurate diagnosis was verified from data in 1007 (74.6%) of these subjects. Univariate analysis showed that level of accreditation of the hospital, age, gender, follow-up department, type of complication, number of outpatient visits, emergent visit, as well as hospitalization were significant factors associated with an accurate diagnosis of diabetes. Multivariate logistic regression analysis revealed that number of outpatient visits, hospitalization, age, and the level of accreditation of the hospital were significant independent factors. The odds ratio of an accurate diagnosis increased with the number of outpatient visits and hospitalization. The probability of accurate diagnosis of diabetes among patients with >/= 4 outpatient visits was 99.16 times greater than that of patients with </= 1 outpatient visit. The probability of accurate diagnosis in patients with >/= 1 hospitalization was 5.26 times that of patients who had not been hospitalized. This study found that the accuracy of diabetes diagnosis in NHI claims data in Taiwan was 74.6%. Further attention to the association of inaccurate claims in cases with infrequent outpatient visits, young age and those attending non-accredited hospitals is needed in order to address the efficiency of diagnosis and surveillance of diabetes in Taiwan.


Accuracy of diabetes diagnosis inhealth insurance claims data in Taiwan

March 2005

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71 Reads

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96 Citations

Journal of the Formosan Medical Association

Background and Purpose: There are limited data from Taiwan about the accuracy of National Health Insurance (NHI) claims data. This study assessed the accuracy of NHI claims data for diabetes and its associated factors. Methods: Insurance claims data for patients with a diagnosis of diabetes were extracted from the records of the Bureau of National Health Insurance, including detailed files of the outpatient, emergency, inpatient and pharmacy treatment records from january 1, 2000 to December 31, 2000. A stratified, 2-staged, probability proportional to size and equal probability method was used to sample 9000 diabetes patients. The accuracy of the diabetes diagnosis was assessed based on patient responses to questionaire items. Subjects with negative or uncertain questionaire answers who had hypoglycemic agents in pharmacy claims data were also classified as diabetic. Results: A total of 1350 questionnaires were returned and an accurate diagnosis was verified from data in 1007 (74.6%) of these subjects. Univariate analysis showed that level of accreditation of the hospital, age, gender, follow-up department, type of complication, number of outpatient visits, emergent visit, as well as hospitalization were significant factors associated with an accurate diagnosis of diabetes. Multivariate logistic regression analysis revealed that number of outpatient visits, hospitalization, age, and the level of accreditation of the hospital were significant independent factors. The odds ratio of an accurate diagnosis increased with the number of outpatient visits and hospitalization. The probability of accurate diagnosis of diabetes among patients with &GE; 4 outpatient visits was 99.16 times greater than that of patients with &LE; 1 outpatient visit. The probability of accurate diagnosis in patients with &GE; 1 hospitalization was 5.26 times that of patients who had not been hospitalized. Conclusions. This study found that the accuracy of diabetes diagnosis in NHI claims data in Taiwan was 74.6%. Further attention to the association of inaccurate claims in cases with infrequent outpatient visits, young age and those attending non-accredited hospitals is needed in order to address the efficiency of diagnosis and surveillance of diabetes in Taiwan.

Citations (3)


... Furthermore, their high prevalence enabled researchers to study these diseases using merely the Longitudinal Health Insurance Database, which is the 1 million-person subset of the NHIRD that entails a lower cost than the whole dataset of the NHIRD. In particular, because the diagnostic codes for diabetes and stroke have been validated within NHI claims data [23][24][25], researchers might be more confident performing research on these diseases. This again emphasizes the importance of case validation in secondary data analysis [26]. ...

Reference:

Two decades of research using Taiwan’s National Health Insurance claims data: A bibliometric and text mining analysis on PubMed (Preprint)
Accuracy of diabetes diagnosis inhealth insurance claims data in Taiwan
  • Citing Article
  • March 2005

Journal of the Formosan Medical Association

... However, this bias could be non-differential in both SU and non-SU cohorts. Additionally, robust consensus between coded diagnoses and clinical criteria has been demonstrated elsewhere [32,33]. Thirdly, individual comorbidities could only be assessed using the CCI, which lacked information such as actual risk factors, underlying etiologies, disease durations, and treatments administered. ...

Accuracy of Diabetes Diagnosis in Health Insurance Claims Data in Taiwan
  • Citing Article
  • April 2005

Journal of the Formosan Medical Association

... [2,3] However, several studies have revealed that current diabetes care still has room for improvement [4][5][6] such as control of risk factors or achieving guideline-recommended targets, of which are usually the main services provided by family physicians to take care of their patients. In Taiwan, specifically, studies have shown suboptimal diabetes care leading to the emergence of vascular complications in patients [7][8][9]. ...

Professional accountability for diabetes care in Taiwan
  • Citing Article
  • March 2006

Diabetes Research and Clinical Practice