機構內成人智能障礙者住院醫療資源耗用之探討

目的一、探討機構內成人智能障礙者住院疾病型態（依據疾病主診斷分類）。二、探討機構內成人智能障礙者住院不同疾病診斷分類在醫療資源耗用之比較。三、探討機構內成人智能障礙者人口學特徵、身心障礙特質、共病數多寡是否可預測住院醫療資源之耗用。四、探討機構內成人智能障礙者人口學特徵、身心障礙特質是否可有效預測住院的有無。五、以結構方程模式探討本研究架構因果模式路徑關係之適配性。方法本研究是採回溯性之次級資料分析。以國內南部某身心障礙教養機構內之成人智能障礙者為主，自92年至95年曾經住院治療之智障者，共161名為研究對象。1.從該機構保健課及教保課內收集住院智障者之資料如下：（1）人口學特徵：年齡、性別、教育程度、婚姻狀態（2）身心障礙特質：智障等級、障礙類別；身體合併其他疾病如精神疾病、癲癇、唐氏症；身體合併其他功能障礙如行動能力、日常生活自理能力、語言表達能力、視力及聽力損傷。2.地區、區域醫院及中央健保局南區分局提供的住院醫療費用清單明細資料檔，包含出入院日期、ICD-9、住院天數及總醫療費用等資料進行統計分析。結果本研究發現，智障者住院最常見診斷群前三名分別為呼系系統、消化系統、皮膚系統。比較不同疾病診斷群在單次住院天數及單次醫療費用前四名分別為腫瘤、內分泌相關疾病、呼吸系統、損傷中毒。逐步淘汰複迴歸分析的結果顯示，共病數、行動能力、日常生活自理能力是智障者住院醫療資源耗用最主要的影響因素，住院次數及總住院天數可以顯著預測智障者個人之總醫療費用。對數迴歸分析的結果，ADL為智障者是否住院的顯著預測因子。結論與建議提升智障者自我照顧能力，嘗試降低共病數、住院次數及總住院天數，應是減少醫療費用之有效方法及未來努力的目標。

關鍵字

成人智能障礙；醫療資源耗用；機構內住院

並列摘要

Objective This study investigated the disease category of hospitalization, the comorbidity of inpatient, the predictors of inpatient utilization of medical resources, and the predictors of hospitalization in institutional adults with intellectual disabilities. A structural equation modeling (SEM) was performed to test the validity of the causal structure of this research. Methods This study was a secondary data analysis. The sample included 161 adults of a handicapped institution, who have been hospitalized during 2003~2006. The information of demographic characteristics and handicapped characteristics was collected from the institution, and the information related to medical record and expenditure of hospitalization was obtained from the community hospitals, area hospitals and Bureau of National Health Insurance. Results This study found that the most common disease-categories were “respiratory disease”, digestive disease”, and “skin disease”. The disease-categories with the highest medical utilization were “tumor”, “endocrine related disease”, “respiratory disease”, and “injury and poisoning”. The stepwise multiple regression analysis showed that the significant predictors of inpatient medical utilization in adults with mental retardation were comorbidity, active level, and self-care ability. The logistic regression analysis showed that the self-care ability was a significant predictor of hospitalization in adults with mental retardation. Conclussion and Suggestion Improving the self-care ability, disease management and decreasing the comorbidity in those institutional handicapped adults, would be an important goal in the future.