探討台灣地區腎臟移植病患趨勢及其影響醫療成效之研究

Trend analysis,resource utilization,and survival of kidney transplantation in Taiwan

李秋華(Chiu-Hua Li)

指導教授 ： 李金德

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(2014年)

https://doi.org/10.6832/KMU.2014.00103

摘要

研究目的
在台灣，末期腎臟疾病發生率排行全球第二名，而盛行率則位居全球之冠，罹病人數與日劇增，造成龐大的醫療費用支出，使健保財務上產生重大的問題與負擔。對末期腎臟疾病治療，腎臟移植是目前對末期腎衰竭治療的首選，然而如何提升醫療品質並控制醫療耗用，則成為重要思考議題。本研究首先探討台灣地區腎臟移植病患盛行率之分布趨勢，接著評估台灣地區末期腎病患者接受腎臟移植的人口學特質、疾病型態及機構特質對於醫療資源耗用之重要影響因素，最後探討腎臟移植病患死亡率之重要影響因素。
研究方法
本研究設計採回溯性之次級資料分析，資料來源為國家衛生研究院「全民健保學術研究資料庫-住院醫療費用清單明細檔」。研究樣本為1996年至2010年間健保住院申報資料，全國健保局申報腎臟移植之病患(手術碼55.69或處置碼76020B)，共計1,918例，排除非適合的樣本，最後本研究之研究樣本共1,877例。以線性複迴歸分析、對數迴歸分析及 COX危害性分析，探討人口學特質(年齡、性別、CCI)、醫療機構特質(醫院層級別、醫院服務量、醫師服務量)等因素對於腎臟移植病患醫療費用及存活分析之影響。
研究結果
研究結果顯示台灣地區腎臟移植病患，平均年齡為39.6歲±12.4歲，平均住院天數為18.4天±13.9天日，平均總醫療費用為250,277元±183,570元。利用線性複迴歸分析，探討1996~2010年台灣地區腎臟移植病患醫療費用之間相關性，在人口學特質中性別、CCI以及醫院服務量與醫療費用具有顯著性意義(p<0.05)。而年齡、性別、CCI與醫院服務量及醫師服務量與住院天數有顯著性意義(p<0.05)。
利用Cox存活分析進行死亡危害與個別因素之差異性檢定，結果顯示影響腎臟移植病患術後存活與年齡、性別、住院天數及與醫療總費用等因素有顯著性意義，研究發現，每當年齡增加1歲，死亡率是原先的1.03倍，男的死亡率是女的1.40倍；醫院服務量中，每增加一例，死亡率是原來的 0.98倍；住院天數每增加一天，死亡率為原來的1.01倍 (P<0.001)；住院費用每增加1元，死亡率是原先的1.01倍 (P<0.001)，而醫療機構特質(醫院層級別、醫院服務量及醫師服務量)皆不會顯著影響腎臟移植病患術後死亡之重要因素。

結論與建議
整體而言，本研究顯示年齡、性別、CCI與腎臟移植病患之醫療費用與存活具有顯著相關性。高服務量的醫療機構會有較佳的醫療療效及醫療資源耗用，議建醫療機構管理者及臨床專家應留意病患狀況及追蹤病患健康及用藥狀況，預防併發症等不良事件，應可提高病患醫療療效與降低醫療費用，以確保病患之醫療品質。
關鍵詞：腎臟移植、趨勢分析、醫療資源耗用、醫療療效

關鍵字

腎臟移植 ； 趨勢分析 ； 醫療資源耗用 ； 醫療療效

並列摘要

Purpose
In Taiwan, the prevalence of renal disease is among the highest in the world, the number and date of morbidity surge, causing huge medical costs, and making a sig-nificant burden on health care and financial problems. Therefore, this study firstly evaluate the trend analysis and then to explore the impact factors of medical resource utilization and mortality in renal transplant patients.

Research Methods
This retrospective nationwide population-based study used the claims data set to evaluate the temporal trend and to explore the risk factors of medical resource utilization and survival analysis from 1996 to 2010 in Taiwan. Kidney transplant patients (55.69 yards or disposal operation code 76020B), excluding non-suitable samples, a total of 1,877 patients were included into the study. Multiple linear regression, logistic regression, and COX proportional hazard models were employed to explore the impact factors of medical resource utilization and mortality rate.

Results
The results showed that kidney transplant patients, on average, the average age was 39.6 years ± 12.4 years, the average days of hospitalization was 18.4 days ± 13.9 light of day ,total medical cost was NT$250,277 ± NT$183,570. Age, gender, CCI and hospital volume have a significant association with total medical cost (P <0.05). Age, gender, CCI, hospital volume, and physician volume also showed a significant association with hospital lengths of stays (P <0.05). Additionally, it showed age, gender, lengths of stay, and total health care costs, The study found that increase of age by one year is associated with 0.03 fold of increase in mortality. Mortality was 1.40 fold higher for male than for female; for hospital volume, one more kidney transplant patient was associated with 0.02 fold decrease in mortality; for days of hospitalization, one more day was associated with 0.01fold increase in mortality (P <0.001);and hospital characteristics (hospitals level, hospital volume and physician volume) were not significantly associated with survival rate among renal transplant patients.
Conclusions and Recommendations
Overall, the study showed that age, gender, and CCI had a significant association with total medical costs and survival rate. Surgeon volume and hospital volume will have better medical efficacy and impact of medical resource utilization. Furthermore, these analytical results should be applicable to most countries with relatively small populations. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.

Keywords:
Kidney transplant, trend analysis, medical resource utilization, health outcomes

並列關鍵字

Kidney transplant ； trend analysis ； medical resource utilization ； health outcomes

參考文獻

中文文獻

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