病患特性之探索與醫療資源耗用－以慢性阻塞性肺部疾病患者爲例

A Study on the Characteristics and Medical Resource Utilization of Patients with Chronic Obstructive Pulmonary Disease

李兆殷(Jhao-Yin Li) ； 林哲暐(Jhe-Wei Lin) ； 吳宗樺(Zong-Hua Wu) ； 吳皓瑋(Haw-Wei Wu) ； 葉家成(Chia-Cheng Yeh) ； 楊雅雯(Ya-Wen Yang)

《醫務管理期刊》 9卷3期 (2008/09) Pp. 159-173

https://doi.org/10.6174/JHM2008.9(3).159

摘要

目的：醫學界預測慢性阻塞性肺部疾病將成為衝擊人類健康的一項主要疾病，而眾多文獻均指出該疾病之醫療資源耗用不容小覷，有鑑於慢性阻塞性肺部疾病之重要值得各界重視，本研究欲尋找出慢性阻塞性肺部疾病慣患之特性，以供相關單位參考。
方法：本研究自全民健保資料庫之「抽樣歸人檔」抽取2000年到2003年之資料進行分析，利用敘述性統計量、自動互動檢視法，將病患進行區隔化分群，最後以邏輯斯迴歸建立患者醫療資源耗用之模型，並藉對比值比率尋找慣患族群之特色。
結果：慢性阻塞性肺部疾病之病患，男性患者比例略高於女性；年齡以65歲以上之老年人所佔比例最高，未滿l歲之嬰兒人口爲最少，綜合慢性阻塞性肺部疾病患者之特性，將之歸為慣患，其特徵為女性、至醫學中心就醫、年齡層屬老年；此外亦尋找出四群潛在慣患之特質。
結論：探知慢性阻塞性肺部疾病患者之特性後，便可針對該特徵予以控制和預防，本研究對台灣未來在慢性阻塞性肺部疾病之預防控制上的資源配置有著指標性的參考作用，同時亦可供未來慢性阻塞性肺部疾病的後續相關研究做為參考。

關鍵字

慢性阻塞性肺部疾病 ； 全民健保資料庫 ； 自動互動檢視法 ； 邏輯斯迴歸 ； 對比值比率

並列摘要

Objective: World Health Organization announced COPD placed the fifth among the causes of death in the world. More and more scholars indicate COPD will consume a great number of medical resources. Thus, a study on COPD is important and urgent. The purpose of this study is trying to find out some significant characteristics of patients with COPD.
Method: To evaluate the characteristics of outpatient service and medical resources spent on the care of outpatients with COPD, data were collected from National Health Insurance Research Database from Year 2000 to 2003, in which there were 105,980 valid samples with total medical expenditure and other variables. Data were analyzed using descriptive statistics to show the demographic of patients. CHAID and logistic regression was conducted to forming a model, then we seek the characteristics of patients by comparing odds ratios.
Result: The major results include: (1) fifty-eight percent of these patients were male. (2) most of the COPD patients aged above 65. (3) the hospitals patients went to were mostly branch hospitals in Taipei, the cases being 41,765 accounting for 39.41% of the total number. (4) we also found that patient with COPD have many characteristics and also found four subset of patient characteristics; thus, the results could be applied to the research of healthcare management.
Conclusion: According to the COPD characteristics in Taiwan, a guideline was provided for relative healthcare organizations to reallocate their medical resources. This study can be used for relative studies of COPD in Taiwan.

並列關鍵字

Chronic Obstructive Pulmonary Disease ； CHAID ； Odds Ratio ； National Health Insurance Research Database ； Logistic Regression

參考文獻

World Health Organization(2000).Health Systems: Improving Performance.The World Health Report.(The World Health Report).,未出版.

World Health Organization(2003).Shaping the Future.The World Health Report.(The World Health Report).,未出版.

衛生統計系列

Murray CJL,Lopez AD(1996).(Evidence based health policy-lessons from the global burden of disease).

中華民國台灣地區2003全民健保主要疾病就診率統計