高危險新生兒的生命指數與醫療資源耗用的影響因素分析

The Effect of High-Risk Newborn Factors on Apgar Score and Medical Resource Utilization

楊雅淑(Ya-Shu Yang)

指導教授 ： 黃偉堯

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00052

摘要

研究背景：中央健康保險局於2010年起實施全民健康保險住院診斷關聯群（Tw-DRGs），以提昇醫療服務效率及改善病患照護品質與療效。Tw-DRGs的分類架構中僅有MDC 15（新生兒與其他源於周產期病態之新生兒）的分類方式與其他主要疾病類別（MDCs）不同，所以本研究分析帶有疾病狀況的高危險新生兒的生命指數（Apgar score）與醫療資源耗用的變化；亦即當新生兒的生命指數越低，表示健康狀況越不佳，相對地所需耗用的醫療資源也可能越多，以提供將來健保局修正MDC 15分類架構的參考。

目的：探討高危險新生兒的生產前、生產中、生產後新生兒狀況的因素，與生命指數（Apgar score）、醫療費用的關係。具體而言，本研究要回答以下兩個問題：
1.生產前、生產中和生產後新生兒狀況的因素與Apgar score是否有關？
2.生產前、生產中和生產後新生兒狀況的因素與新生兒醫療費用是否有關？

研究設計：本研究為次級資料縱斷面研究設計，分析新生兒的Apgar score與醫療費用變化。以母親生產前、生產中及生產後新生兒狀況的影響因素為共同的自變項，同時分析其對新生兒的第一分鐘和第五分鐘Apgar score，及住院年齡小於或等於28天的新生兒住院醫療費用是否有影響。

資料來源：本研究採次級資料分析。使用國民健康局2008年的「出生通報檔」，分析生產前、中、後因素對Apgar score的影響；使用國家衛生研究院全民健保資料庫2008年的「住院醫療費用清單明細檔」和「承保資料檔」，分析生產前、中、後因素對新生兒住院醫療費用的影響。

研究對象：分析生產前、中、後因素對Apgar score的影響時，以2008年出生之新生兒研究對象；分析生產前、中、後因素對新生兒住院醫療費用的影響時，以2008年入院年齡≦28天之新生兒為研究對象。

主要結果測量：新生兒的第一分鐘和第五分鐘Apgar score，及健保住院醫療費用。

主要結果：
1.當生產前、中、後的特定危險因素存在時，第一分鐘或第五分鐘Apgar score小於7分的風險會增加。
2.當生產前、中、後的特定危險因素存在時，新生兒的健保住院醫療費用會偏高。
3.Apgar score的二元羅吉斯迴歸分析：
3.1當生產前的母親年齡≧35歲、孕期酗酒、藥癮、母體糖尿病、母體心臟病和母體高血壓；生產中的羊水異常、羊水中有胎便、臍帶脫垂、胎盤早期剝離和生產方式的剖腹產；生產後的妊娠週數＜37週、出生體重＜1,500公克、出生體重1,500-2,499公克、出生體重＞4,500公克等危險因素存在時，第一分鐘Apgar score小於7分的風險會增加。
3.2當生產前的母親年齡≧35歲、孕期酗酒和母體糖尿病；生產中的羊水異常、羊水中有胎便、臍帶脫垂和胎盤早期剝離；生產後的妊娠週數＜37週和妊娠週數＞42週，出生體重＜1,500公克、出生體重1,500-2,499公克、出生體重＞4,500公克等危險因素存在時，第五分鐘Apgar score＜7分的風險會增加。
4.住院醫療費用的複迴歸分析：生產前的母親年齡≧35歲、孕期酗酒、母體糖尿病、母體腎臟病、母體貧血、三胞胎以上；生產中的產程太長、羊水異常、羊水中有胎便和剖腹產；生產後的妊娠週數＜37週和出生體重＜1,500公克和介於1,500-2,499公克者等危險因素存在時，新生兒的住院醫療費用會偏高。

結論：當生產前、生產中、生產後新生兒狀況的特定危險因素存在時，會同時影響新生兒的第一分鐘和第五分鐘Apgar score、健保住院醫療費用。而其中當母親年齡≧35歲、孕期酗酒、母體糖尿病、羊水異常、羊水中有胎便、妊娠週數＜37週，及出生體重＜1,500公克和1,500-2,499公克等8項危險因素，會同時使新生兒的第一分鐘和第五分鐘Apgar score＜7分的風險增加，相對地新生兒的健保住院醫療費用也會增加；亦可間接呈現Apgar score與新生兒的住院醫療費用可能有相關。

關鍵字：高危險新生兒、生命指數（Apgar score）、醫療資源耗用、生產前因素、生產中因素、生產後新生兒狀況

關鍵字

高危險新生兒 ； 生命指數 ； 醫療資源耗用 ； 生產前因素、生產中因素 ； 生產後新生兒狀況

並列摘要

Background. The Taiwan Bureau of National Health Insurance (BNHI) wants to improve health care efficiency and quality by Taiwan Diagnosis-Related Groups (Tw-DRGs) in 2010. The classification framework of MDC 15 (Newborns and Other Neonates with Conditions Originating in the Perinatal Period) is the only one which is different from the other Major Diagnostic Categories (MDCs) of Tw-DRGs. Therefore, this study analyzes the variation about Apgar score and medical resource utilization of high-risk newborn. That is, when a newborn infant has lower Apgar socre which represents poor health status, and may need more medical resources relatively. This study can provide suggestions for BNHI which modifies Tw-DRGs classification framework of MDC 15 in the future.

Objectives. To investigate the relationship of high-risk newborn factors (antepartum factors, labor factors and postpartum factors) with Apgar score and inpatient expenditure. There are two questions of the study:
1.Is there any relationship between high-risk newborn factors and its Apgar score ?
2.Is there any relationship between high-risk newborn factors and its inpatient expenditure ?

Designs. Secondary and longitudinal study. To analyze the relationship between high-risk newborn factors (antepartum factors, labor factors, postpartum factors) and Apgar score (1-minute and 5-minute); and between high-risk newborn factors and inpatient expenditure of patients’ age≦28 days at the time of admission.

Data. The first is Birth Registration Database in 2008, which obtained from Bureau of Health Promotion, Department of Health, R.O.C (Taiwan). This data would like to analyze the relationship of antepartum factors, labor factors and postpartum factors with Apgar score. The second is Inpatient expenditures by admission in 2008, which obtained from National Health Insurance Research Database (NHI). This data would like to analyze the relationship of antepartum factors, labor factors and postpartum factors with inpatient expenditure of infant.

Subjects. This study has two subjects. One subject is infants born in 2008 to analyze the relationship of antepartum factors, labor factors and postpartum factors with Apgar score. The other subject is NHI patients’ age≦28 days at the time of admission in 2008 to analyze the relationship of antepartum factors, labor factors and postpartum factors with inpatient expenditure of NHI.

Main outcome measures. 1-minute Apgar score, 5-minute Apgar score, and inpatient expenditure of NHI.

Results.
1.When infants had some certain risk conditions of antepartum factors, labor factors and postpartum factors, which increases risks for 1-minute Apgar score <7 and 5-minute Apgar score <7.
2.When infants had some certain risk conditions of antepartum factors, labor factors and postpartum factors, which increases inpatient expenditure of NHI.
3.The binary logistic regression analysis of Apgar score:
3.1Maternal age≧35 years at delivery, drug/alcohol use during pregnancy, a mother suffered from diabetes mellitus, hypertension or heart disease, oligohydramnios or polyhydramnios, meconium stained amniotic fluid (MSAF), prolapsed cord, abruptio placentae, caesarean section, gestational age <37 weeks, birth weight <1,500g, birth weight 1,500-2,499g, birth weight >4,500g will increase risk of 1-minute Apgar score <7.
3.2Maternal age≧35 years, alcohol use during pregnancy, a mother suffered from diabetes mellitus, oligohydramnios or polyhydramnios, meconium stained amniotic fluid (MSAF), prolapsed cord, abruptio placentae, gestational age <37 weeks, gestational age >42 weeks, birth weight <1,500g, birth weight 1,500-2,499g, birth weight >4,500g will increase risk of 5-minute Apgar score <7.
4.The multiple regression analysis of inpatient expenditure of NHI: Maternal age ≧35 years, alcohol use during pregnancy, a mother suffered from diabetes mellitus, renal disease or anemia, triplet or more, prolonged labor, oligohydramnios or polyhydramnios, meconium stained amniotic fluid (MSAF), caesarean section, gestational age <37 weeks, birth weight <1,500g and birth weight 1,500-2,499g will increase inpatient expenditure of NHI.

Conclusions. Maternal age≧35 years, alcohol use during pregnancy, a mother suffered from diabetes mellitus, oligohydramnios or polyhydramnios, meconium stained amniotic fluid (MSAF), gestational age <37 weeks, birth weight <1,500g and birth weight 1,500-2,499g will increase risks of 1-minute Apgar score <7, 5-minute Apgar score <7, and increase inpatient expenditure of newborn. This shows potential correlation between Apgar score and inpatient expenditure of newborn.

Key words: high-risk newborn , Apgar score, medical resource utilization, antepartum factors, labor factors, postpartum factors.

並列關鍵字

high-risk newborn ； Apgar score ； medical resource utilization ； antepartum factors ； labor factors ； postpartum factors

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