探討髖部骨折手術病人下轉其它醫療機構對其醫療資源利用及效果之研究

The impact of referring down to lower medical institutions on medical resources utilization and outcomes among hip fracture surgery patients

黃秀琴(Hsiu-Chin Hwang)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2019年)

摘要

研究目的
髖部骨折（Hip Fractures）是人口老化所導致的一個全球性的公共衛生問題，基於急性後期照護精神，復健治療可由醫學中心透過下轉系統將病人轉至具有就醫可近性、便利性之其他醫療機構，除降低大醫院病床擁塞情形外，對醫療資源的利用將更具效益，因此，本研究首先探討髖部骨折手術病人術後有無下轉至不同醫療機構治療，進而評估其醫療資源利用及醫療效果之相關重要影響因素。
研究方法
研究樣本採回溯性研究設計(Retrospective Study)，利用全民健保學術研究資料庫之2005年百萬承保抽樣歸人檔，1997年1月1日至2013年12月31日間進行初次髖部骨折手術(主要診斷碼為ICD-9-CM code 820.0~820.19、820.2~820.32、820.8、820.9手術治療代碼ICD-9-code 79.15、79.35、81.52、81.53)，最後納入研究樣本為10,534人。本研究利用線性複迴歸、邏輯斯複迴歸及Cox迴歸分析評估髖部骨折手術病人人口學特性、醫療臨床特性及醫療機構特性對於醫療資源利用及醫療效果之重要影響因子。
研究結果
本研究結果發現，整體有下轉組共7,500人，其中醫學中心下轉區域醫院有223人、地區醫院387人、診所1,740人，區域醫院下轉地區醫院527人、診所2,507人，地區醫院下轉診所有2,116人。研究結果亦發現，病人人口學特性、醫療臨床特性及醫療機構特性與其術後醫療資源利用及醫療效果具有顯著性相關(p<0.05)，髖部骨折手術病人術後下轉至其他醫療機構進行更進一步醫療復健，每位病人平均將可節省2,262.21元，全國執行髖部骨折手術平均將可節省548,092,763元。
結論與建議
結論
本研究主要探討髖部骨折手術病人下轉其它醫療機構，其人口學特性、醫療臨床特性、醫療機構特性對醫療資源利用及效果之差異，研究結果發現髖部骨折手術病人有無下轉其它醫療機構的平均年齡以65-7歲居多、性別以女性居多。
髖部骨折手術病人有無下轉其它醫療機構其術後醫療平均費用之比較，發現每個研究樣本人可節省2,262.21元，依此推估，全國人口髖部骨折手術病人下轉其它醫療機構對其醫療資源利用及效果，每年可節省548,092,763元。
建議
術後醫療資源利用及醫療效果不僅跟病人人口學特性及醫療臨床特性有關，醫療機構特性也有關，對於即將接受髖部手術的病人，提供醫療復健教育之參考也是非常重要的影響因子；再者，髖部骨折手術病人下轉至其他醫療機構將可節省巨大醫療費用，可提供衛生主管機關於政策擬定之參考。

關鍵字

髖部骨折 ； 下轉 ； 醫療資源利用 ； 醫療效果

並列摘要

Purposes
Hip Fractures is a global public health problem caused by aging population. Based on the acute post-care spirit, rehabilitation therapy should be transferred from a medical center to a regional or district hospital for accessibility and convenience through the transfer system. Other medical institutions, in addition to reducing the congestion of large hospital beds, the use of medical resources will be more effective. Therefore, this study first explores whether patients with hip fracture surgery can be transferred to different medical institutions for a further treatment, and evaluates risk factors of medical resources utilization and medical outcomes.
Methods
The retrospective study, using the 2005 million-insurance sampling of the National Health Insurance Academic Research Database, and the first hip fracture surgery was performed between January 1, 1997 and December 31, 2013 (The main diagnostic codes were ICD-9-CM code 820.0~820.19, 820.2~820.32, 820.8, 820.9 and surgical procedure codes 79.15, 79.35, 81.52, 81.53), and finally included 10,534 samples. Multiple linear regression, logical regression, and Cox regression analysis were employed to evaluate the demographic characteristics, medical clinical characteristics and medical institution characteristics of hip fracture patients, which were important factors influencing medical resource utilization and medical outcomes.

Results
It found that there were a total of 7,500 people in the group, from medical centers including 223 patients to regional hospitals, 387 patients to distric hospitals and 1,740 referr to clinics; then from regional hospitals referred to distric hospitals had 527 patients and 2,507 to clinics; 2,116 patients in the transfer clinic. It also found that the demographic characteristics, medical clinical characteristics and medical institution characteristics were significantly correlated with postoperative medical resource utilization and medical outcomes (p<0.05). Further medical rehabilitation, each patient will save an average of NT$2,262.21, the national implementation of hip fracture surgery will save an average of NT$548,092,763.
Conclusion and Implication
Postoperative medical resource utilization and medical effects are not only related to the patient's demographic characteristics and medical clinical characteristics, but also related to medical institutional characteristics. Rehabilitation education for patients arranged for hip fracture surgery was important, in addition, hip fracture surgery patients transferred down to other lower medical institutions will save huge medical costs, which can provide health authorities on the policy draft reference.

並列關鍵字

hip fracture ； downturn ； medical resource utilization ； medical outcome

參考文獻

英文文獻

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