背景:糖尿病為全體國人帶來嚴重危害，其中又以山地原鄉地區的原住民族面臨最大的挑戰。我國為改善糖尿病照護品質，於2001年開辦糖尿病論質計酬方案。近年來我國衛生所功能逐漸轉型，醫療保健功能逐漸弱化，然而，山地原鄉因地緣特殊以至於醫療資源輸送不易，衛生所之於山地原鄉地區仍有其重要性。過去探討糖尿病論質計酬方案的研究之研究場域並非針對山地原鄉地區，目前仍缺乏以山地原鄉地區衛生所為主體，進而分析糖尿病照護品質與糖尿病論質計酬方案的研究報告。
目的:1.山地原鄉與其他地區各層級醫療機構糖尿病照護人數分布；2.山地原鄉與其他地區各層級醫療機構參與糖尿病論質計酬比例；3.山地原鄉與其他地區之糖尿病照護品質差異；4.不同地區衛生所、診所、醫院之糖尿病照護品質差異；5.山地原鄉與其他地區有無參與論質計酬機構之糖尿病照護品質差異
方法:本研究採用量性研究方法並利用次級資料進行分析，以衛福部健保署「全民健保醫療品質資訊公開網」為主要資料來源，收集2011至2019年全國醫療機構各項糖尿病照護品質指標執行資料。將收集資料依據縣市別、地區別、醫療機構層級、糖尿病病人照護量、品質指標項目以及年代等特徵分組，透過描述性統計呈現糖尿病照護機構與糖尿病人分布趨勢，瞭解各地區別與各醫療機構層級之糖尿病照護品質執行成果，分析山地原鄉地區衛生所糖尿病照護概況；透過邏輯斯迴歸模型，控制上述變項並解釋各變項與糖尿病照護品質的相關性。
結果:本研究發現，各地區糖尿病人至診所就醫比例逐年升高，尤其又以一般地區診所比例明顯增長影響最多，2011-2019年增加了5.65%。全國糖尿病照護品質指標執行率皆逐年提升，以地區別來說，一般地區機構表現最好，山地原鄉地區機構次之，醫療不足地區機構表現最差，依醫療機構層級來看，衛生所於各地區別表現皆較同地區其他機構層級還好。衛生所的表現雖好，但在各地區的影響占比卻不盡相同，其中又以在山地原鄉地區仍有近4成的糖尿病人照護比例最顯著，山地原鄉地區衛生所實際參與論質計酬方案與糖尿病人加入論質計酬照護的比例高達93.55%、69.82%，不僅高於其他地區的衛生所，也大幅高於其他地區不同層級的機構，這是讓山地原鄉地區的糖尿病人獲得較佳照護品質的主要原因。透過邏輯斯複迴歸，控制縣市別、糖尿病病人照護量以及年代等變項，發現山地原鄉地區衛生所各項照護品質指標執行勝算皆高於一般地區醫院，加入論質計酬照護執行勝算甚至是一般地區醫院的13.49倍。檢視山地原鄉地區衛生所糖尿病照護概況發現，至2019年，山地原鄉地區衛生所尚有2家未參與糖尿病論質計酬方案，總體來說，山地原鄉地區衛生所各項照護品質指標執行率皆比全國整體表現還好。
結論: 過往的文獻大多指出，偏遠地區、機構層級低的醫療機構所提供的糖尿病照護品質應當弱勢，但本研究結果卻與預期相反。山地原鄉地區衛生所於糖尿病照護服務上具有特殊性與重要性，影響因素可能與屬於山地原鄉相關的醫療支援、補償政策、健康計畫以及公衛護理師所扮演的重要角色有關。

The act of implementation and effectiveness of diabetes P4P program in the public health canters in mountain indigenous township remains to be discussed. This study collected open data from the Medical Quality Information of NHI, to construct the distribution of persons with diabetes and generate insights of diabetes health disparities. Multiple logistic regression analysis was conducted to examine the correlation between the levels of health care facility and the quality measures of diabetes care. The distribution of persons with diabetes had been shifting from hospitals and public health centers to private primary clinics in all areas. Comparing different levels of health care facility, public health centers had the highest achievement among hospitals and private primary clinics. Nonetheless, public health centers only made a significant impact on mountain indigenous townships; according to the evidence that nearly 40% of the persons with diabetes in mountain indigenous townships were under diabetes care from the public health centers. The diabetes P4P program engagement rate and the patient P4P enrollment rate of the public health centers in mountain indigenous townships was 69.92% and 93.55%, respectively. Comparing to the hospitals in urban areas, the public health centers in mountain indigenous townships had a greater odds ratio of all quality measures. Studies have shown that persons with diabetes in remote areas or from lower levels of health care facility received poor quality of diabetes care. On the contrary, our study demonstrates the public health centers in mountain indigenous townships had great achievements on diabetes care.

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