Title

探討大腳趾外翻手術之成本與醫療療效分析

Translated Titles

The Cost and Outcomes Evaluation after Hallux Valgus Surgery

Authors

李佳樺

Key Words

大腳趾外翻 ; 盛行率 ; 醫療療效 ; 成本 ; 效益 ; Hallux Valgus ; Prevalence ; Medical utilization ; Cost

PublicationName

高雄醫學大學醫務管理暨醫療資訊學系碩士在職專班學位論文

Volume or Term/Year and Month of Publication

2015年

Academic Degree Category

碩士

Advisor

許弘毅

Content Language

繁體中文

Chinese Abstract

研究目的 為了改善大腳趾外翻病人之手術型態,進而瞭解其成本與效益及其影響之因素做為探討,以作為日後改善之依據。故本研究將以整體成本與效益分析之結果,配合臨床執行醫師狀況,對大腳趾外翻手術病人的醫療成本與相關因素進行分析,以維持適當病患之醫療品質。 研究方法 本研究採用縱貫性(次級資料庫)分析,以回溯性方式進行研究設計,分別如下: 第一:以國家衛生研究院全民健康保險學術資料庫為資料來源,採用2000年百萬全國抽樣歸人檔資料。收案對象為1996年至2010年共15年篩選取出初次接受大腳趾外翻(手術健保碼:64133C)並接受大腳趾外翻切骨手術(ICD 9診斷碼:735.0)之病患為研究對象,樣本數為12,975人。 第二:以台灣南部某醫學中心之層級醫院病歷回溯(Chart Review)資料庫為資料來源。收案對象為2008年1月至2013年12月共6年選出診斷確診為大腳趾外翻(手術健保碼:64133C)並接受大腳趾外翻切骨手術(ICD 9診斷碼:735.0)之病患為研究對象,樣本數為390人。研究對象來源主要是針對該醫學中心執行兩種不同方式手術的病患進行研究調查。 研究工具為SPSS 20.0統計套裝軟體執行統計分析,分為描述性統計(包括平均值、標準差、次級分配及百分比)與推論性統計(包括卡分檢定、複迴歸分析、對數迴歸分析)之統計方法,最後針對兩種手術方式進行成本與效益分析。 研究結果 一、 依據中央健保署1996年∼2000年統計納保人數資料進行分析,初次接受大腳趾外翻手術盛行率情形,由1996年盛行率每十萬人口1.3%,逐年顯示增加至2010年7.6%;而當次住院天數(從1996年平均6.9天上升至2010年7.8天)及平均總醫療費用(從1996年平均30,642元上升至2010年61,759元)長期趨勢有逐年上升。 二、 影響初次接受大腳趾外翻手術當次住院醫療資源利用的因子有性別、年齡、疾病嚴重度、醫院層級、醫院手術量及醫師手術量等,其中以女性族群為最多,64歲以下佔平均總醫療費用有2,335人、65歲以上佔平均總醫療費用有10,449人,均達顯著性差異。 三、 以某醫學中心病歷資料庫進行分析來看,在當次手術住院情形特殊材料費(傳統術式平均費用為509元±924元、改良式平均費用為8,986元±806元)及醫療總費用(傳統術式平均費用33,385元±9,124元、改良式平均費用為41,900元±7,080元)均達顯著性差異。 結論與建議 研究發現大腳趾外翻盛行率逐年上升,接受大腳趾外翻手術所耗用的醫療資源比例增加。由於本研究病歷回溯僅分析六年間醫療資源使用情形,尚無法進一步瞭解兩組手術病人長期趨勢變化情形,故未來應加強建立更完整之大腳趾外翻手術資料庫,以利進行更深入之臨床結果追蹤及分析,藉以瞭解兩組成本效益之變化,進而提出相關建議可供政府部門、醫療機構與臨床專業醫師作為參考,以確保大腳趾外翻手術之效果能有效被監控。以本研究對某醫學中心之研究,施行臨床路徑之住院日及醫療耗用均比健保百萬歸人檔為低,頗值參考,尤其健保在TW-DRGs住院診斷關聯群第二階段103年7月導入後更是必循之趨勢。

English Abstract

Purpose Hallux valgus (HV) is reported to be the most common pathological condition affecting the great toe, usually presenting in women between 50 and 70 years of age. Despite the huge and growing global burden of HV, high-quality population-based studies of HV prevalence and outcomes are scarce. This study purposed to analyze temporal trends and predictors of cost and hospital resource utilization in a population of patients who had received HV surgery. Methods This population-based patient cohort study retrospectively analyzed 12,975 patients who had received surgical treatment for HV (ICD-9-CM procedure code 735.0) from 1996 to 2010. The study period was divided into three equal time intervals (period 1: 1998~2001; period 2: 2002~2005; and period 3: 2006~2009). Odds ratio (OR) and 95% confidence interval (95% C.I.) were determined to assess the temporal trend in each factor when using period 1 as the reference group in comparison with period 3. Multiple linear regression models were used for multivariate assessment of cost and hospital resource utilization predictors. Results The prevalence rate of HV patients significantly increased by 484.6% from 1.3 per 100,000 persons in 1996 to 7.6 per 100,000 persons in 2010 (p<0.001). Age, gender, Deyo-Charlson co-morbidity index (CCI) score, hospital volume, surgeon volume, and hospital level were significantly associated with HV surgical outcomes (p<0.05). However, over the 15-year period analyzed, the lengths of stay (LOS) and the total medical costs increased, from 6.9 days to 7.8 days, and NT$30,642 to NT$61,759, respectively. The estimated mean overall survival time after HV surgery was 182.4 months (SD 3.2 month), and the overall 1-, 3-, 5-, and 10-year survival rates were 98.7%, 94.1%, 89.7%, and 87.1%, respectively. Conclusion and suggestion The prevalence of HV surgery has been increasing dramaticually, especially in female patients. Facing this remarkable phenomenon, the health policy and the pattern of medical consumption has changed, and so we suggested that the following studies could take items of self expense, patient’s health condition, and information about drug usage into account. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學院 > 醫務管理暨醫療資訊學系碩士在職專班
社會科學 > 管理學
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