近端股骨骨折接受手術病患之盛行率及醫療資源耗用分佈趨勢及其影響因素探討

Trends and Risk Factors Analysis of Prevalence and Hospital Resource Utilization in the patients with proximal femur fracture undergoing surgical treatment

陳澍群(Shu-Chiun Chen)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2012年)

摘要

研究目的

台灣正在往高齡化人口結構演進。因此探討近端股骨骨折接受手術病患之盛行率及醫療資源耗用是刻不容緩的議題。

一、探討近端股骨骨折接受手術病患之盛行率分佈趨勢及其相關影響因素。
二、探討近端股骨骨折接受手術病患之醫療資源耗用分佈趨勢及其相關影響因素。

研究方法

本研究是採取回溯性縱貫性研究設計，利用國家衛生研究院釋出之全民健康保險研究資料庫住院DD檔之次集資料建立。研究樣本為1996年至2010年，主/次診斷為近端股骨骨折及接受手術的病患。探討近端股骨骨折接受手術病患之盛行率及醫療資源耗用分佈趨勢及其影響因素。

研究結果

一、 近端股骨骨折接受手術病患每十萬人口盛行率之分佈趨勢有顯著增加
(1996年56.9/100,000，2010年89.3/100,000，p<0.001)。

二、 近端股骨骨折接受手術病患住院天數之分佈趨勢有顯著減少
(1996年15.9天 2010年9.3天, p<0.001)。
年齡、合併症嚴重指數(CCI)、醫院層級、醫院服務量、手術方式與近端股骨骨折接受骨折手術病患的住院天數呈正相關(p<0.001)。
醫院類型、醫師服務量與近端股骨骨折接受骨折手術病患的住院天數呈負相關(p<0.001)。
其中以醫師服務量影響住院天數最大。

三、 近端股骨骨折接受手術病患醫療總費用分佈趨勢有顯著增加
(1996年77351.8元 2010年77936.9元, p<0.001)。
合併症嚴重指數(CCI)、醫院類型、醫院服務量、手術方式與近端股骨骨折接受骨折手術病患的醫療總費用呈正相關(p<0.001)。
年齡、醫院層級、醫師服務量與近端股骨骨折接受骨折手術病患的醫療總費用呈負相關(p<0.001)。
其中以手術方式影響醫療總費用最大。

結論與建議

本研究運用全國性大型資料庫，共追蹤15年，探討近端股骨骨折接受骨折手術病患之盛行率及醫療資源耗用分佈趨勢及其影響因素分析比較，為長期並完整之深入研究。
本研究結果顯示近端股骨骨折接受手術病患之盛行率有顯著增加，且醫療總費用也有增加的趨勢，但住院天數有顯著減少。時間特性、人口學特性、臨床特性與近端股骨骨折接受骨折手術病患之住院天數及醫療總費用皆有顯著的相關。
本研究結果發現，影響近端股骨骨折接受手術病患之盛行率及醫療資源耗用之因素與國外文獻研究結果一致。

關鍵字

近端股骨骨折 ； 盛行率 ； 醫療資源耗用

並列摘要

Purpose
Taiwan is toward an aging population structure in the future. Therefore, the discussion of the trends and risk factors analysis of prevalence and hospital resource utilization in the patients with proximal femur fracture undergoing surgical treatment is an urgent issue. This study purposes
1. To evaluate the trends and risk factors analysis of prevalence in the patients with proximal femur fracture undergoing surgical treatment.
2. To explore the trends and risk factors analysis of hospital resource utilization in the patients with proximal femur fracture undergoing surgical treatment.

Methods
This study is designed with a retrospective longitudinal method. We used the National Health Insurance Research Inpatient Database and collected the sample from 1996 to 2010 with the main and secondary diagnosis was proximal femur fracture undergoing surgical treatment.

Results
1. The prevalence of the patients with proximal femur fracture undergoing surgical treatment is significantly increasing from 56.9/100,000 in 1996 to 89.3/100,000 in 2010 (p<0.001).
2. The Length of Stay (LOS) of the patients with proximal femur fracture undergoing surgical treatment is significantly decreasing from 15.9 days in 1996 to 9.3 days in 2010 (p<0.001).

There are significant positive correlations between LOS, age, CCI, hospital level, and hospital volume (p<0.001).
There are significant negative correlations between LOS, type of hospital, and physician volume (p<0.001).
The physician volume is the main determinant of LOS.
3. The total medical cost of the patients with proximal femur fracture undergoing surgical treatment is significantly increasing from NT77,351.8 in 1996 to NT77,936.9 in 2010 (p<0.001).
There are significant positive correlations between total medical cost, CCI, hospital type, hospital volume, and surgical procedure (p<0.001).
There are significant negative correlations between total medical costs, age, hospitals level, physician volume (p<0.001).
The surgical procedure is the main determinant of total medical cost.

Conclusion
In this study, a large national database to track a total of 15 years and it is also a long-term and in-depth study of the discussion of the trends and risk factors analysis of prevalence and hospital resource utilization in the patients with proximal femur fracture undergoing surgical treatment.
The results of this study show that the prevalence and total medical costs of the patients with proximal femur fracture undergoing surgical treatment are significantly increasing and the LOS of the patients with proximal femur fracture undergoing surgical treatment is significantly decreasing. Time, demographic characteristics, and clinical characteristics are significant influenced of the LOS and total medical costs.

The results of this study are consistent with other countries literature studies about the prevalence and medical resource utilization of the patients with proximal femur fracture undergoing surgical treatment.

並列關鍵字

proximal femoral fractures ； prevalence ； medical resource utilization

參考文獻

<中文文獻>

行政院衛生署

http://www.doh.gov.tw/

中華民國骨質疏鬆症學會

http://www.toa1997.org.tw/