探討頭部外傷手術病患盛行率、醫療資源耗用及 
死亡率之分佈趨勢及其影響因素

研究目的：運用國家衛生研究院釋出之「全民健康保險研究資料庫-住院檔」之次級資料建立。研究樣本為 1996 至 2010 年間健保申報資料，主/次診斷碼為頭部外傷的患者挑選條件依據疾病及有關健康問題國際統計分類系統之第九修訂版進行 ICD9-CM 主(次)診斷碼為頭部外傷之診斷群，800、801、803、804、850、851、 852、853、854 的個案為研究樣本。探討頭部外傷手術患者接受手術治療之醫療資源耗用(當次住院天數、病房費、治療費、手術費、藥費、當次醫療總費用)並計算死亡率的分佈趨勢及影響因素。研究結果：本研究期間頭部外傷手術病患存活人數 52,928 例(57.0%)，頭部外傷手術病患平均住院天數為 19.57±16.79 日，依據中央健保局 1996 年-2010 年統計納保人數資料進行分析。1996 年盛行率為 27.29(每十萬人口數)，逐年增加至 2010 年盛行率達 31.82(每十萬人口數)，在統計學上達到顯著差異。住院的醫療總費用包含病房費、治療費、手術費、藥費等項目，平均頭部外傷手術病患醫療總費用為 261,904±295,666 元，其中以病房費平均費用佔最高為 72,806±90,831 元。整體而言，病房費、治療費、手術費、藥費皆呈現上升趨勢。分別以出院後 30 天及 90 天再住院率來比較，30 天再入院者有 2,304 例(2.5%)，90 天再入院者有 2,753 例 (3.0%)。結論與建議：頭部外傷病患導因仍以交通事故為主，依據本研究結果瞭解醫療資源耗用分佈，建議將醫療資源重新適當分配使用，並且運用頭部外傷治療準則，提高醫療效能，維持良好醫療品質。

關鍵字

頭部外傷手術病患；醫療資源耗用

並列摘要

Aims: To evaluate the prevalence, medical resource utilization and mortality rate in traumatic brain injury (TBI) patients after Surgery. Methods: The primary/secondary diagnosis code of TBI patients selected according to the ICD9-CM diagnostic code diagnosis of TBI, 800, 801, 803, 804, 850, 851, 852, 853, and 854 were included into the study. The χ2 for trend, multiple linear regression, lo-gistic regression, and Cox proportional hazards models were employed to evaluate the prevalence and to explore the predictors of medical resource utilization and mortality rate. Results: The 52,928 survival TBI patient had a mean hospital stay was 19.57 ± 16.79 days, according to the National Health Insurance Bureau of Statistics 1996 -2010. In 1996 prevalence was 27.29 (per 100,000 population), increasing to 31.82 (per 100,000 pop-ulation) in 2010 annually, reaching a statistically significant difference. Total medical costs were NT$261,904 ± 295,666, which accounted for an average cost of ward fees of up to NT$72,806 ± 90,831. Overall, ward fees, treatment fees, surgery, drugs are on the rise. Respectively, readmission within 30 days or 90 days after discharge was 2.5% and 3.0%. Conclusions and Recommendations: Conduction due to TBI patients accidents still mainly based on the results of this study to understand the distribution of medical resource utilization, it is recommended to re-appropriate allocation of medical resource utilization and the use of TBI treat-ment guidelines to improve medical performance, maintaining a good quality of care.

並列關鍵字

head trauma patients ； medical resource utilization ； readmission within 30 days or 90 days ； mortality rate

參考文獻

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交通部(2013)˙機踏車登記輛數˙2014年5月10日取自http://stat.motc.gov.tw/mocdb/stmain.jsp?&sys=238&ym=1&outmode=551&spcmk=2&term=120&fldcnt=1&fldlist=225220170!!!!!!!%BE%F7%BD%F1%A8%AE%B5n%B0O%BD%F8%BC%C6!!6!0!0!0!0!!7606!