台灣醫療次區域心導管室密度與急性冠狀動脈症候群病患預後之關係

Relationship between the Density of Cardiac Catheterization Room in Sub-medical Regions in Taiwan and the Prognosis of Patients with Acute Coronary Syndrome.

嚴元鴻(YUAN-HUNG YEN)

指導教授 ： 李淑芬

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2019年)

摘要

背景：心血管疾病久居國民十大死亡原因第二位，其中急性冠狀動脈症候群 (Acute Coronary Syndrome，簡稱ACS) 死亡人數約佔全年心臟疾病死亡人數七成。ACS發生時能愈快打通阻塞的地方，越能夠搶救更多的心臟肌肉，也越能夠保留心肌梗塞病患後續的生活自理能力。而ACS病患是否能儘速就醫，與就近是否有能處理心導管的醫院有關。因此該地區具備心導管室醫院的數量對ACS病患預後有顯著影響。本研究目的即為探討醫療次區域內可執行心導管醫院數量與急性冠狀動脈症候群病患預後之關聯。
方法：本研究以國家衛生研究院發行之2010年「全民健康保險研究資料庫」的資料進行回溯性分析。本研究樣本為2010年百萬人次抽樣檔中之急性冠狀動脈症候群住院病患，以邏輯斯迴歸分析在控制年齡、性別、投保薪資、共病症、醫院層級、居住地區醫師數以及面積等變項後，醫療次區域內可執行心導管之醫院密度對於樣本發生14天、30天內再住院及14天、30天內死亡之影響。
結果：本研究樣本共計有1738位。在控制病患、醫院與地區醫療資源特性後，發現該醫療次區域內可執行心導管之醫院密度對於4個主要研究結果 (14天與30天內再住院，以及14天內與30天內死亡率) 而言，都不具有明顯的影響力。樣本該次住院的醫院心導管量與再住院的風險有關；而年齡對於死亡結果有顯著的影響。
結論：在台灣心導管室的密度對於該地區急性冠狀動脈症候群病患預後並沒有明顯的影響，找出高風險病患給予合適的治療、以及促進非醫學中心醫院對於急性冠狀動脈症候群的治療才能提供更高的效益。

關鍵字

健保資料庫 ； 急性冠狀動脈症候群 ； 醫療次區域 ； 心導管室

並列摘要

Background: Cardiovascular disease ranks second in the Taiwan’s top ten causes of death. Among them, the death from Acute Coronary Syndrome (initialism: ACS) accounts for about 70% of the total number of heart disease deaths throughout the year. During ACS, the faster doctor can rebuild the blood flow to the infarcted area, the more myocardium can be rescued, and the more self-care ability of patients with ACS can be retained. Whether there is a hospital that can provide cardiac catheterization, and whether patients with ACS can seek medical treatment as soon as possible. Therefore, the number of cardiac catheterization providing hospitals in the region has a significant impact on the prognosis of ACS patients. The purpose of this study was to investigate the association between the number of cardiac catheterization providing hospitals in the medical sub-region and the prognosis of patients with acute coronary syndromes.
Method: This is a retrospective study analyzing the 2010 Taiwan’s National Health Insurance Research Database. The sample of this study was hospitalized patients with acute coronary syndrome in the 2010 Longitudinal Health Insurance Database. After controlling age, gender, insured salary, comorbidities, hospital-level, number of physicians and area of a medical sub-region, the logistic regression was used to analyze the density of cardiac catheterization providing hospitals in the medical sub-region affected the re-hospitalization within 14 days and 30 days, and death within 14 days and 30 days of the sample.
Result: The total number of samples in this study was 1,738. After controlling the characteristics of patients, hospitals and medical resources in the districts, the density of cardiac catheterization providing hospitals in the medical sub-region was found to be no obvious influence to all the 4 major results (re-hospitalization within 14 days and 30 days, and death within 14 days and 30 days). The volume of cardiac catheter of the hospital of the hospitalization was related to the risk of re-hospitalization; age had a significant effect on the outcome of the death.
Conclusion: in Taiwan, the number of cardiac catheterization room has no significant effect on the prognosis of patients with acute coronary syndromes in the medical sub-region. Identifying high-risk patients and treating optimally, and promoting the treatment of acute coronary syndromes in non-medical central hospitals, are much more efficiency.

並列關鍵字

medical sub-region ； National Health Insurance database ； Cardiac catheterization room ； Acute coronary syndrome

參考文獻

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