應用全民健保資料庫分析台灣壓力性損傷病人之醫療資源利用

Using the National Health Insurance Database to Analyze the Medical Resource Utilization of Pressure Injury Patients in Taiwan

張碧鈴(Bi-Ling Chang)

指導教授 ： 丘周萍

義守大學/醫學院/護理學系/碩士(2021年)

摘要

目的：本研究藉由分析全民健保資料庫，探討臺灣壓力性損傷之清瘡手術後的住院病人醫療利用差異性及醫療費用的情形。
設計：本研究利用2010年至2018年的全民健保資料庫進行研究，以壓力性損傷之清瘡手術後的住院病人為研究對象。
結果：本研究經篩選後，共選取2571位研究對象進行回溯性研究，男性為1270 人，女性為1301人，年齡層約集中在60歲以上，約佔整體的84.0%。共病因子以腦中風(11.7%)人數最多。2010年至2018年間每年有約3900萬至5500萬元的健保費用在壓力性損傷手術治療上，總醫療費用為4億2仟元。分期及損傷部位以薦骨(41.41%)及第4期(47.3%)發生最多，使用獨立t 檢定發現不同性別、脊髓損傷、失智症、髖部骨折、四肢麻痺及腦中風在住院就醫次數、住院醫療費用達統計顯著差異，影響住院總醫療費用之因素有年齡，就醫科別-外科及整形外科，重建手術-游離皮膚移植術，手術後併發症-敗血症、肺炎、急性呼吸衰竭是統計上有顯著的影響因素。
結論：在現今醫療照護的技術的不斷進步下，本研究的資料顯示壓力性損傷每年住院接受手術治療人數仍無減少，顯示預防、管理和衛教非常重要。護理人員對壓力性損傷的評估時，應儘早將高危風險群轉介給相關個案管理師、社工人員、營養師等，其早期預防壓力性損傷的發生可減輕病人傷口痛苦，挽救其生命，減少數龐大的個人醫療保健支出。

關鍵字

壓力性損傷 ； 健保資料庫 ； 醫療利用 ； 醫療費用

並列摘要

Aim：By analyzing the National Health Insurance database, this study explored the differences in medical utilization and medical expenses of inpatients after pressure injury debridement in Taiwan.
Methods：This study analyzed the data of the National Health Insurance Research Database from 2005 to 2010. The subjects of the study were the patients after the debridement of pressure injury.
Results：2571 subjects were selected for retrospective research. There are 1270 males and 1301 females, and the age group is 60 years old and above, accounting for 84.0% of the total. Stroke (11.7%) was the most common comorbidity factor. From 2010 to 2018, about 39 million to 55 million NT dollars of health insurance expenses were spent on surgical treatment of pressure injuries each year, with a total medical expenses of 420 NT million. The stage and site with the highest incidence are the stage 4(47.3%) and the sacrum(41.41%), respectively. Using independent t-test, it was found that there were statistically significant differences in the number of admissions and hospitalization expenses for different gender, spinal cord injury, dementia, hip fracture, quadriplegia, and stroke. Factors that affect the total medical expenses of hospitalization were age, surgery, plastic surgery, revision of pedicle or flap graft, postoperative complications-sepsis, pneumonia, acute respiratory failure were statistically significant influencing factor.
Conclusion：With the advance of medical care technology, the data of this study show that the number of hospitalized patients with pressure injuries who receive surgical treatment has still not decreased each year, indicating that prevention, management and health education are very important. When assessing pressure injuries, nurses should refer high-risk groups to relevant case managers, social workers, and dietitians as soon as possible. Early prevention of stress injuries can alleviate the pain of patients' wounds, save their lives and reduce huge personal medical and health care expenses.

並列關鍵字

Pressure injury ； National Health Insurance Research Database ； Medical utilization ； Medical expense

參考文獻

一、中文部份

台灣失智症協會．認識失智症．取自 http://www.tada2002.org.tw/tada_know_02.html

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