雪山隧道通車對宜蘭縣急性心肌梗塞病患救治結果之影響

Did The Treatment Outcomes for Yilan's Acute Myocardial Infarction (AMI) Patients Improve after the Opening of the Hsuehshan Tunnel?

林宜靜(I-Ching Lin) ； 李淑芬(Shu-Fen Li) ； 蔡偉德(Wei-Der Tsai)

《台灣公共衛生雜誌》 31卷4期 (2012/08) Pp. 388-397

https://doi.org/10.6288/TJPH2012-31-04-09

摘要

目標：本研究旨在分析2006年6月雪山隧道開通，對宜蘭縣急性心肌梗塞病患的短期死亡率與再住院率之影響。方法：以2004年6月至2008年6月之宜蘭縣急性心肌梗塞住院病患資料，利用羅吉斯特迴歸模型分析雪隧通車是否影響宜蘭縣急性心肌梗塞病患的醫療結果；並以花蓮縣病患為對照組，利用差異中的差異分析方法，比較宜蘭縣與花蓮縣病患救治結果的平均差異。結果：雪隧通車後，宜蘭縣急性心肌梗塞病患的出院後30天內死亡率顯著降低；相較於花蓮縣，雪隧通車後宜蘭縣急性心肌梗塞病患死亡率確實獲得改善；但對再住院率則無顯著影響。結論：透過重大交通建設縮短交通距離與時間，有助於提升醫療資源與人力流動的便捷性，最終使病患的救治結果獲得正向影響。

關鍵字

雪山隧道 ； 急性心肌梗塞 ； 死亡率 ； 再住院率

並列摘要

Objectives: The purpose of this paper was to investigate whether there was an improvement in the treatment outcomes for AMI patients in Yilan County after the opening of the Hsuehshan Tunnel on June 16, 2006. The Hsuehshan Tunnel connects Taipei City with Yilan County and substantially cuts down the traveling time between the two regions. It may facilitate the migration of medical manpower between the two regions and increase accessibility to medical center hospitals for Yilan's inhabitants. Methods: By using the 2004-2008 National Health Insurance Database, we estimated the changes in the 30-day mortality rate and readmission rate of Yilan's AMI patients via the logistic regression model and difference-in-differences. Results: We found that 30-day mortality rates for AMI patients in Yilan County did decline after the opening of the Hsuehshan Tunnel. This finding persisted when AMI patients in Yilan County and Hualien County were compared via difference-in-differences. There was also a decline in the readmission rates; however, it was not statistically significant. Conclusions: The treatment outcomes for Yilan's AMI patients did improve after the opening of the Hsuehshan Tunnel. Transportation facilities have a positive effect on the treatment outcomes for AMI patients living in less accessible areas because of the migration of medical manpower to regions with improved transportation.

並列關鍵字

Hsuehshan Tunnel ； Acute Myocardial Infarction ； Mortality ； Readmission

參考文獻

林民浩、楊安琪、溫在弘(2011)。利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則。台灣衛誌。30，347-61。

洪乙禎、林錦鴻(2010)。探討醫療資源和民眾健康差異的相關性─以台灣二十三縣市粗死亡率和事故傷害死亡率為例。台灣衛誌。29，347-59。

章殷超、溫在弘、賴美淑(2009)。利用地理資訊系統探討肝癌病患就醫地理可近性與醫院選擇間之相關性。台灣衛誌。28，517-29。

蔡文正、龔佩珍、楊志良、李亞欣、林思甄(2006)。偏遠地區民眾就醫可近性及滿意度調查。台灣衛誌。25，394-404。

Arcury, T.A.,Gesler, W.M.,Preisser, J.S.,Sherman, J.,Spencer, J.,Perin, J.(2005).The effects of geography and spatial behavior on health care utilization among the residents of a rural region.Health Serv Res.40,135-55.