急性心肌梗塞醫療照護成果之健康體系相關因素探討

Health System Factors Associated with Outcome of Care for Acute Myocardial Infarction

張冠民(Guann-Ming Chang) ； 劉樹泉(Shu-Chuen Lau) ； 董鈺琪(Yu-Chi Tung)

《醫護科技期刊》 12卷1期 (2010/03) Pp. 26-34

https://doi.org/10.6563/TJHS.2010.12(1).3

摘要

目標：本研究旨在探討哪些健康照護體系因素與急性心肌梗塞醫療照護成果具有相關性。方法：本研究是以全民健保資料庫2007年13358位急性心肌梗塞住院病患爲研究對象，使用邏輯斯迴歸分析，在控制病患特性及所在區域後，探討健康照護體系因素（包括週末住院、醫師專科別與服務量、醫院服務量、權屬別、評鑑等級、是否爲教學醫院）與急性心肌梗塞住院死亡之間的關係。結果：在控制病患性別、年齡、合併症指數、手術與否、醫師年齡及所在區域後顯示，非週末住院、較高的醫師服務量、心臟專科醫師照護及教學醫院與減少急性心肌梗塞住院死亡有關。結論：急性心肌梗塞病患週末住院較平常日住院有較高的住院死亡風險，較高的醫師服務量與較低的急性心肌梗塞住院死亡風險有關，心臟專科醫師治療的住院死亡風險相較其他非內科醫師爲低，教學醫院治療的住院死亡風險亦較非教學醫院爲低。

關鍵字

急性心肌梗塞 ； 照護成果 ； 死亡率

並列摘要

Objective: This study examines which health system factors are associated with outcome of care for acute myocardial infarction (AMI). Method: 13358 AMI patients admitted in 2007 were collected from the National Health Insurance Research Database in Taiwan. Multiple logistic regression was employed to examine associations of health system factors (including weekend admissions, physician specialty and volume, hospital volume, ownership, accreditation level and teaching hospital or not) with in-hospital AMI mortality, adjusted for patient characteristics and geographic location. Results: Weekday admissions, higher physician volume, cardiologist care and teaching hospitals were associated with lower in-hospital AMI mortality after controlling for patient gender, age, comorbidities, surgical operation, physician age, and geographic location. Conclusions: AMI patients admitted on weekends had higher mortality than those admitted during weekdays. Higher physician volume is associated with lower in-hospital AMI mortality. Furthermore, patients cared for by cardiologists have lower mortality than those cared for by non-internists. Additionally, patients admitted to teaching hospitals have lower mortality than those admitted to nonteaching hospitals.

並列關鍵字

Acute myocardial infarction ； outcome of care ； mortality rate

參考文獻

臺彎衛生網路

吳肖琪、簡麗年、吳義勇(2004)。探討術前合併症指標與醫療利用及手術相關結果之關聯性一以全股（髖）關節置換健保申報資料為例。臺灣公共衛生雜誌。23(2)，121-129。

李冬蜂、吳肖琪(2004)。論病例計酬實施前後冠狀動脈繞道手術病患死亡情形。臺灣公共衛生雜誌。23(4)，305-315。

Abubakar,I.,Kanka,D.,Arch,B.,Porter,J.,Weissberg,P.(2004).Outcome after acute myo-cardial infarction: A comparison of patients seen by cardiologists and general physicians.BMC Cardiovascular Disorders.4,14-14.

Allison,J.J.,Kiefe,C.I.,Weissman,N.W.,Person,S.D.,Rousculp,M.,John O.Canto,M.,Bae,S.,Williams,O.D.,Farmer,R.,Centor,R.M(2000).Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI.Journal of the American Medical Association.284(10),1256-1262.