探討良性攝護腺增生病人採不同術式後的 併發症與術前合併症之關聯

The Association Between Complications after The Adoption of Different Operations and Preoperative Comorbidities for Benign Prostate Hyperplasia Patients

袁得峻(Te-Chun Yuan)

指導教授 ： 張怡秋 ； 胡雅涵

國立中正大學/管理學院/資訊管理學系/碩士(2015年)

摘要

良性攝護腺增生(Benign prostatic hyperplasia,BPH )是一種老年人常見的疾病，隨著國人平均餘命增加與老年人口迅速增加，老年人的的醫療需求與生活品質逐漸受到重視，BPH患病後不但影響病人生活品質，高發生率也對醫療資源造成影響。目前醫病之間的認知存在著差距，若能縮小病人在BPH術式上認知的差距並在治療方式上取得共識，及時告知病人治療的利弊及可能面臨的風險與後果，澄清不切實際的期待與決定，再進一步說明可供選擇或替代治療的方案作為參與醫療決策的基礎，就能提升醫病雙方決策後的滿意度及病人參與醫療決策的動機與自信。
研究資料來源為國家衛生研究院發行之2010年健保資料庫承保抽樣歸人檔，使用就醫資料檔案為「門診處方及治療明細檔」、「住院醫療費用清單明細檔」、「住院醫療費用醫令清單明細檔」，為求研究對象一致性，本研究資料收集從2005年至2010年區間的BPH病人，排除非手術治療的病人後，選取2006年~2008年間首度採取BPH常使用之術式刮除手術與切開手術治療的病人為研究對象，再利用健保資料庫檔案間相互共通欄位將病人就醫資料檔案串聯後，依術式類型將選取的病人區分，再分別選取二種術式病人之術後二年併發症與術前一年合併症，經資料清洗整理後，採用Weka3.6.6版本做為本研究資料探勘工具，再應用關聯規則中Apriori技術進行資料探勘與資料處理分析。
研究樣本共有540人，研究結果發現：二種術式病人年齡主要分佈在61-80歲區間，切開手術有較高比率在60歲以下被採用，手術病人多數患有一個以上的合併疾病，術前除泌尿道相關疾病外心臟病與高血壓疾病有較高機率伴隨BPH出現，術後最常見併發症為泌尿道感染。

關鍵字

資料探勘 ； 健保資料庫 ； 良性攝護腺增生 ； Apriori

並列摘要

Benign prostate hyperplasia (Benign prostatic hyperplasia, BPH) is a common disease for the elderly. With the increase in average life expectancy of people and the growing number of the elderly, the need of healthcare and the quality of life for them is gradually valued. Having BPH not just affects the quality of life of patients. Moreover, its recurrence can have a great impact on medical resources. At present time, cognition gaps may exist between patients and healthcare professionals. Patient satisfaction can be enhanced after the decision made by both sides and so can the motivation and self-confidence of patients’ involvement in medical decision making only if the gaps in patients’ cognition pertinent to BPH surgery can be closed and mutual consensus on the treatment can be achieved. This, coupled with the fact that patients are promptly informed of the pros and cons of the treatment and of the potential risks and consequences they possibly face, will help clarify unrealistic expectations and decisions, to be more precisely, further explanation about treatment option or alternative treatment can be available as the basis for participation in medical decision-making.
Research sources are Longitudinal Health Insurance Database(LHID) from 2010 National Health Insurance Research Database(NHIRD) issued by National Institutes of Health, from which NHI ambulatory files are used, including Ambulatory care expenditures by visits(CD), Inpatient expenditures by admissions(DD), Details of inpatient orders(DO). For sample consistency, the data in this study was collected from 2005 to 2010 BPH patients, excluding patients with non-surgical treatment. The participants who took BPH operation commonly used for the treatment of curettage surgery and incision surgery are selected from 2006 to 2008. And data fields from the claims data are used to merge with data files of basic characteristics of patients. The complications occurring within 2 years of post-operative treatment as well as the comorbidities occurring within one year before pre-operative treatment are chosen separately.
After data cleansing, Weka3.6.6 version is used as data mining tools in this study. Next, the association rules are applied into Apriori techniques for data processing and analysis.
A total of 540 people are recruited in this study. The research findings are as follows. The age distribution of patients with two different types of operation is between 61-80 years old. A higher percentage of patients under the age of 60 are more likely to receive incision surgery, the majority of whom suffering from more than one comorbidity. For example, in addition to disease-related urinary tract disease, a higher percentage of heart disease and high blood pressure occur with the appearance of BPH, while the most common complication after surgery is urinary tract infection.

並列關鍵字

Data Mining ； National Health Insurance Research Database(NHIRD) ； Benign prostate hyperplasia ； Apriori

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