台灣5歲以下嬰幼兒事故傷害住院之醫療利用

The Characteristics and Patterns of Medical Care Utilization of Hospitalized Injured Children under Age 5 in Taiwan

黃耀緯(Yao-Wei Huang) ； 鍾其祥(Chi-Hsiang Chung) ； 朱基銘(Chi-Ming Chu) ； 簡戊鑑(Wu-Chien Chien)

《醫務管理期刊》 11卷3期 (2010/09) Pp. 1-18

https://doi.org/10.6174/JHM2010.11(3).1

摘要

目的：探討5歲以下兒童事故傷害住院之各項特性，包含病患、環境及傷害特質與醫療利用型態之關係。
方法：本研究以2007年健保「住院醫療費用清單明細檔(DD)」，擷取診斷欄位「外因分類一」及「外因分類二」為E800~E999者進行分析。分別探討病患、環境及傷害特質與手術處置、住院天數及醫療費用之關係，使用統計方法包含次數百分比及羅吉斯迴歸分析。
結果：2007年台灣0~4歲兒童傷害住院計4,117人，有進行手術處置者共2,146人(52%)，住院者平均住院天數為5.29天，醫療總花費為193,480,710元。在病患特質方面，男童人數(n=2,391)是女童(n=1,726)的1.39倍；年齡以1歲所佔比例最高25.77%。在環境特質方面，醫院層級，以區域醫院比例最高53.33%；而都市化程度，以中都市化市鎮比例最高55.28%。在傷害特質方面，傷害類型以跌倒墜落比例最高(28.49%)；受傷部位（診斷類型）以上肢及下肢骨折比例最高(15.5%)。另外，有關醫療利用型態方面，1歲兒童發生重複傷害的比例最高(28.19%)；而發生傷害導致上下肢骨折較須進行手術處置（上肢OR=33.11，95%C.I.=14.50~75.58；下肢OR=15.92，95%C.I.=6.68~37.92）；且有手術處置者住院天數與醫療費用分別比未手術處置者高出2.58天與52,810.5元。
結論：傷害造成的骨折對兒童身體及醫療資源的損耗均相當嚴重，相關單位應積極研擬防制策略，降低兒童傷害的發生。

關鍵字

傷害 ； 兒童 ； 住院 ； 醫療利用 ； 全民健保

並列摘要

Objective: The aim of this study was to understand the hospitalization characteristics of injured children aged 0-4 in Taiwan and to determine the patterns of utilization of their medical care.
Methods: This research used data under external cause coding (E800~E999) from ”Inpatient expenditures by admissions (DD)” in the 2007 National Health Insurance Research Database for analysis. The statistical analysis was performed on such variables as patient characteristics (gender, age, and number of hospitalizations), environmental characteristics (hospital level and degree of urbanization), injury characteristics (types and location), and patterns of medical care utilization (surgical treatment, hospital stay, and cost). Logistic regression analysis was used to identify factors that influenced medical care utilization.
Results: In 2007, there were 4,117 hospitalized injured children aged 0~4 in Taiwan. Of these, 2,146 (52%) required surgical treatment. The average hospital stay was 5.29 days, and the total medical cost was NT$193, 480, 710. For patient characteristics, the number of boys (2,391) was 1.39 times the number of girls (1,726) and the 1-year-olds had the highest proportion of admissions at 25.77% (n=1,061). For environmental characteristics, the regional hospitals had the highest percentage of admissions at 53.33% (n=2,196) while the town-based degree of urbanization showed the highest percentage at 55.28%. For injury characteristics, falls accounted for the highest percentage (28.49%); and fractures of upper and lower limbs were most common (15.5%). For patterns of medical care utilization, 1-year-olds had the most repeat injuries (28.19%). Upper and lower limb fractures required the most surgery (OR of upper limb=33.11, 95%C.I.=14.50~75.58; OR of lower limb=15.92, 95%C.I.=6.68~37.92). The hospital stays and medical expenses of surgical inpatients were highest at 2.58 days and NT$52,810.50.
Conclusions: Childhood fractures result in physical damages and significant costs in medical resources. Authorities should develop prevention strategies to reduce childhood injuries.

並列關鍵字

injury ； child ； hospitalization ； medical care utilization

參考文獻

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