椎間盤突出手術資源耗用與醫療品質 相關之研究-以某區域教學醫院為例

A Research of Relationship between Medical Resource Utilization and Healthcare Quality On Herniated Intervertebral Disc Surgery－Taking a Regional Teaching Hospital for an Example.

黃建鈞(CHIEN-CHUN HUANG)

指導教授 ： 趙建蕾

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

目的：近年我國健保面臨嚴峻考驗，醫療費用過高及預算不足，能夠永續經營，醫療費用管控為主要關鍵，是先進國家共同面臨的棘手課題。
方法：採次級資料回溯性(retrospective)研究法，對象資料擷取自中部地區某地區教學醫院2016年1月1日始至2018年12月31日，期間實施腰部椎間盤突出手術的病患納為研究對象，共計362人。
結果：本研究男性較多(51.1％)，31歲到59歲有153人(42.3％)及60歲以上有188人(51.9％)，BMI值18.5到25有166人(45.9％)及大於25到30有134人(37％)。醫療申報費用與術後感染，達統計學上的顯著差異(P=0.03)。醫療申報費用與出院14日內再返院，達統計學上的顯著差異(P=0.00)。醫療申報費用與住院天數，達統計學上的顯著差異(P=0.00)，病患住院天數越高，其醫療申報費用越高；自費骨材費用與住院天數，達統計學上的顯著差異(P=0.00)。病患住院天數越高，其自費骨材費用越高。
結論：本次研究新式手術為醫院近年開始推廣，樣本數尚不足，在本次研究無法有效地呈現真實的狀況，未來需要再把研究時間拉長且收案數更多或是要進行多家醫院同時進行研究，才能有效的表現出實際狀況，代表全國腰部椎間盤突出手術患者進行研究、討論。

關鍵字：椎間盤突出手術、醫療資源耗用、醫療品質。

關鍵字

資源耗用 ； 醫療品質 ； 椎間盤突出手術

並列摘要

OBJECTIVE
In recent years, China's health insurance has faced severe tests. Medical expenses are too high and budgets are insufficient. It is able to operate sustainably. The management of medical expenses is the key, and it is a difficult issue faced by advanced countries.
METHODS
The retrospective study method was adopted. The data of the subjects were obtained from the patients in a regional teaching hospital in the central region from January 1, 2016 to December 31, 2018, during which patients with lumbar disc herniation were performed. For the study, a total of 362 people.
RESULTS
There were more males (51.1%) in this study, 153 (42.3%) from 31 to 59 years old and 188 (51.9%) over 60 years old, and 166 (45.9%) and greater than BMI values 18.5 to 25. There are 134 (37%) between 25 and 30. There was a statistically significant difference between the medical declaration fee and the postoperative infection (P=0.03). The medical declaration fee was returned to the hospital within 14 days after discharge, and there was a statistically significant difference (P=0.00). There was a statistically significant difference between the medical declaration fee and the hospitalization days (P=0.00). The higher the hospitalization days, the higher the medical declaration fee; the self-funded aggregate cost and the hospitalization days were statistically significant ( P = 0.00). The higher the hospital stay, the higher the cost of the self-funded bone material.
CONCLUSION
This study of new surgery for the hospital began to promote in recent years, the number of samples is still insufficient, in this study can not effectively present the real situation, the future needs to lengthen the study time and the number of cases is more or more At the same time, the hospital can carry out research to effectively display the actual situation and conduct research and discussion on behalf of patients with lumbar disc herniation in the country.

Key words: Resource Utilization、Healthcare Quality、Medical Care Expenses、Herniated Intervertebral Disc Surgery

並列關鍵字

Resource Utilization ； Healthcare Quality ； Medical Care Expenses ； Herniated Intervertebral Disc Surgery

參考文獻

中文文獻

王鈺婷（2015）。外科加護病房靜脈營養支持對使用呼吸器病人之醫療品質及資源耗用探討。取自華藝線上圖書館系統。

吳孟珊, &蘇淑芬(2016)。動態內固定裝置（ISOBAR）應用於腰椎融合手術之護理。護理雜誌, 63(2), 120–126。https://doi.org/10.6224/JN.63.2.120

林文莉(2015)。髖部骨折病人術後療效和醫療資源使用。高雄醫學大學。讀取於自 http://www.AiritiLibrary.com/Publication/Index/U0011-0208201517514900

周亮君（2018）。探討傳統融合與動態脊椎非融合手術醫療資源耗用與療效之研究（碩士論文）。取自華藝線上圖書館系統。