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Metabolic Syndrome Management Program

  • 瀏覽數:瀏覽數:576
  • 修改日:修改日:2024/01/17
  • 發布日:發布日:2023/06/12

 

Metabolic Syndrome Management (MetS) Program

Key features

  • Focusing on pre-disease patients
  • Introduce lifestyle changes as a viable alternative to medications and central to medical services.
  • Paid by NHI fund for universal access
  • Recruitment via existing outpatient and checkup practice.
  • Instructions with curated teaching materials and evidence-based risk assessment tools.
  • Assist patients in achieving self-imposed health targets.

Prevalence of metabolic syndrome

Taiwan’s adult health checkup reveals that 3.7 out of 10 adults aged above 40 have metabolic syndrome. Having this disorder means that people are metabolically abnormal but have yet been diagnosed with a particular disease. However, those people are already at a significantly higher risk of catching heart disease, diabetes, stroke, or other chronic illnesses and thus warrant great attention.

Lifestyle changes: Key to reversing course

Research shows that the occcurence of metabolic syndrome can be largely attributed to behavioral factors such as diet, activity level, or tobacco use. But with appropriate interventions, people are empowered to adopt a lifestyle by quitting smoking, changing their diet, and monitoring their health regularly, which will improve the underlying disorders and prevent them from contracting a disease.

Results of cross-departmental cooperation

Health Promotion Administration (HPA) rolled out the MetS program in 2022 in partnership with National Health Insurance Administration (NHIA) to incorporate lifestyle intervention as part of the existing outpatient medical and checkup services. Participating medical providers and personnel may claim NHI payments for identifying and enrolling pre-disease patients to the program. Those whose patients show improvements in the respective metrics will receive additional performance rewards.

Latest progress

      As of the end of 2022, around 2000 physicians at 1,000 clinics nationwide had enrolled over 20,000 patients.

Potential outcome

With health instructions, proactive health management, and monitoring, we look forward to empowering patients to turn around their health. The outlook here is promising, as corroborated by experience from the US DPP (Diabetes Prevention Program). The patients at a pre-diabetes stage could reduce up to 58% of disease risk in three years following interventions in the form of weight loss, dietary change and increase in physical activity.

Ultimately, the goal is to create a new social dynamic where people start viewing lifestyle interventions as the go-to means for addressing chronic conditions and proactively seek help from cessation providers, dieticians, or exercise specialists, which will be the key to eliminate the current over-relience on medications and excessive use of the health system.


Design & implementation of the MetS program

 

Providers’ eligiblity:

  1. Clinics: A certified provider of Adult Health Checkup 
  2. Physicians: 
     
    Meeting either 1 of the 2 requirements:
     
    I. Being a family physician, internist, or engaging in Adult Health Checkup or Diabetes Shared-care Program;
     II. Having completed a 4-hour introductory traning.

Targeted risk factors and corresponding interventions:

Behavioral:

  1. Smoking
     I. Instructions on smoking cessation.
     II. Referral to a certified smoking cessation provider for more care (provided in-house when available).
  2. Betel quid use
     I. Instructions on betel quid cessation.
     II. Referral to oral mucosa examination (provided in-house when available)

Health measurements:

  1. Waist circumfence and BMI
     Instructions on diet, exercise, and waist circumfence control.
  2. Blood pressure
     Instructions on diet, exercise, and blood pressure measurement.
  3. Blood sugar
     Instructions on diet, exercise, and blood sugar management.
  4. Blood fat
     Instructions on diet, exercise, and blood fat management.

 


 

 

Work and payment schedule

Base payments:

  1. Case enrollment (900 NHI points*):
     Eligibility confirmation, profile creation, risk factor profiling, risk assessment, insturction provision, and assist patients in determining health targets.
  2. Follow-up (200 NHI points):
     Contact the patients via phone call, outreach visit, or clinic appointment, each at least 12 weeks apart, to monitor the progress and provide additional instructions and resources.
  3. Yearly evaluation (500 NHI points):
     Thoroughly evaluate the patient’s progress in the 5 metabolic indicators, following at least 3 follow-ups and at least 12 weeks apart from the previous follow-up.

Reward payments:

  1. Yearly clinic performance (5,000 to 10,000 NHI points, varied by relative performance):
     Based on a clinic’s cummulative outcome of all cases it enroll within the calendar year.
  2. Discovery of an undiagnosed patient (150 NHI points): 
     For enrollment of a chronic disease patient under 40 that had not been previously diagnosed to the MetS program.
  3. On target or improvement (500 NHI points)
     Patients have any 3 of the metabolic indicators meeting the self-imposed targets or showing significant improvement.
  4. Full completion (1,000 NHI points):
     Patients have any 3 of the metabolic indicators within the reference range, stopped relevant medications, and been discarged from the program.

*NHI point is settled quarterly according to the period’s expenditure and fluctuates between NTD$ 0.8-1.2.

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