探討死亡或病危自動出院的住院病人使用安寧療護服務概況

The Utilization of Palliative Care Analysis among Inpatients who Died or were Discharged under Critical Condition

林珊伊(San-I, Lin) ； 許添貴(Tien-Kuei, Hsu)

《安寧療護雜誌》 23卷1期 (2018/03) Pp. 18-34

https://doi.org/10.6537/TJHPC.201803_23(1).02

摘要

研究目的：接受安寧療護服務的人數已逐年提高，安寧的醫療費用支出與健保給付也不斷地成長。但病人最後一次住院時，使用安寧療護服務的相關因子則少被討論。研究方法：本研究使用衛生福利部衛生福利資料科學中心資料庫2010年1月至2013年12月「Health-02全民健保處方及治療明細檔_住院」兩百萬人抽樣檔進行取樣。採用IBM SPSS統計套裝軟體進行分析。結果：在1,107,600筆住院人次分析，有32,367人次為死亡或病危自動出院，以男性(58.1%)、中老期75-84歲者(30.0%)、罹患癌症(32.4%)居多；其中有2680人次(8.3%)為安寧療護案件。而進一步分析出院時死亡或病危出院之32,367人次，在各變項中接受安寧療護服務比例較高者，分別是女性病人(8.7%)、中年期(45-65歲)(11.8%)、罹患癌症(23.6%)、急性病房住院1天以下(26.8%)、提供或轉介安寧療護服務者為女性醫師(22.1%)、健保局東區分局(14.3%)、宗教財團法人醫院(20.2%)、內科系(9.3%)及沒有進行手術(25.5%)。結論：在出院時死亡或病危自動出院的病人中，使用安寧療護服務與病人性別、年齡、罹癌、住院天數、診療醫師性別、醫院區域、醫院權屬別、就醫科別及手術次數等變項有顯著差異。研究結果可提供臨床工作者早期介入安寧療護及安寧政策推動的參考。

關鍵字

安寧療護 ； 死亡 ； 病危自動出院 ； 住院病人 ； 醫療利用

並列摘要

Purpose: More and more patients accept palliative care, and the medical utilizations of palliative care are increasing in Taiwan. Many researches showed palliative care can save medical expenditure and increase the quality of life in terminal patients. We explored the factors related to the utilization of palliative care among inpatients, who died or were discharged under critical condition. Methods: We used the database of the ＂Inpatient Expenditures by Admissions＂ with a random sample of 2,000,000 persons obtained from the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW), and selected the inpatients who died or were on critical against medical advice discharge from Jan, 2010 till Dec, 2013. We analyzed the utilization of the palliative care. Results: There were total 1,107,600 inpatients from 2010 till 2013, and 32,367 patients died (61.4%) or were discharged under critical condition (38.6%). We disclosed the male patient (58.1%), middle old elder (75 to 84 years old) (30.0%), and diagnosis with cancer disease (32.4%) were most in these group separately. Female patient (8.7%), middle age (45-64 years old) (11.8%), diagnosis with cancer disease(23.6%), admission within one day (26.8%), female physician (22.1%), hospital area in the East (14.3%), religious hospital (20.2%), department of internal medicine (9.3%), and patients without surgical intervention (25.5%) within 32,367 inpatients have more possibility of the palliative care utilization. Among these inpatients, there were 2,680 (8.3%) received palliative care. Conclusions: Inpatient's sex, age, diagnosis with cancer or not, admission days, physician's sex, hospital location, hospital ownership, department of medicine, and surgical intervention frequency were statistically significant difference with implementation of palliative care. These findings would provide a reference for clinicians and polices toward promotion of palliative care.

並列關鍵字

palliative care ； death ； discharge under critical condition ； inpatient ； medical utilization

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