心血管疾病患者遠距照護平台資訊探勘

Data Mining of Information Platform of Patients with Cardiovascular Diseases Served by Telehealth

何奕倫(Yi-Lwun Ho)

指導教授 ： 翁崇雄

共同指導教授 ： 余峻瑜(Jun-Yu Yu)

國立臺灣大學/管理學院/資訊管理組/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00481

摘要

隨著醫藥衛生的發達，台灣人口的平均壽命不斷增加；高齡及少子化是先進國家共同面臨的社會趨勢，因此醫療資源的投入應以預防、治療與照護並重。從組織資訊系統種類與建構策略來看遠距照護平台資訊系統，主要類型可分為1)類比於交易處理系統(Transaction Processing System, TPS)的客服平台、2) 類比於管理資訊系統 (Management Information System, MIS)的每日生理參數上傳量測系統。這些系統彼此串接，並與醫院的臨床記錄、抽血資料、放射線檢查報告及超音波檢查資料結合，形成一個完整的整合資訊平台。臺大醫院遠距照護中心提供給個案使用的生理監測儀器有心電圖、血壓、血氧、血糖等，由家屬協助或自行測量，測量後的數值直接經由網路送至臺大醫院資料庫，個案管理師可以針對個案上傳的數據給予個別化的居家照護建議。若生命徵象判讀有異常者，個管師即刻追蹤，並於線上提供相關的緊急護理諮詢，必要時可以諮詢中心值班的主治醫師。此外，個管師給予病友電話追蹤訪談，訪談內容包含：居家照護期間之疾病的進展、家屬照護指導、飲食衛教、提醒回診時間、設備使用障礙排除等。若個案或家屬有任何的疑問，也可以致電遠距照護中心詢問，務必給予個案最周詳的服務。從心血管疾病的遠距照護資料分析中發現：接受遠距照護的患者，其血壓與血糖的控制隨遠距照護時間越長控制越好、高齡或非高齡族群在總醫療支出與住院支出均有降低、但僅有非高齡組在住院率與住院天數有明顯統計學差異。在客服平台與每日生理參數上傳量測系統的資料探勘顯示：客服電話中照護問題的處理最多、其次為生命徵象問題處理。照護問題中，最大宗為病人需要關懷，佔了61.83%。其次為提醒量測生理數值，佔17.68%。在作業處理問題上，掛號安排最多，佔43.65%，其次為詢問抽血結果，佔17.46%。利用高科技的生理參數傳送與便捷迅速的資料探勘，可以使心血管疾病的患者改善其醫療支出與醫療結果。

關鍵字

高齡少子化 ； 遠距照護平台資訊系統 ； 總醫療支出 ； 住院支出 ； 住院率 ； 住院天數

並列摘要

In light of aging and low-birth-rate trends, both of which will increase the medical and caretaking burden of individuals and the nation as a whole. National Taiwan University Hospital (NTUH) established the Telehealth Center in August 2009 via the integration of medicine and information technology. It provides several innovatory business models including real-time long-distance health care services, customized health services and management, and immediate help of handling paroxysmal or sudden episodes. Case managers provide constant health education and nursing counseling to strengthen the patients' ideas of health management and promote their health promotion awareness so that they take good care of their own health. Moreover, it resolves our people’s demand for health care by minimizing consumption of overall medical care resources. The platforms of Telehealth center of NTUH include a immediate response platform which is similar to a Transaction Processing System and a daily physiologic data uploading platform which is similar to a Management Information System. From the data mining of the above system, we could found that the mean blood pressure was reduced and the fasting blood glucose was reduced after telehealth services. The mean duration of hospital stay and admission rate were reduced in non-senior group after telehealth service. The total medical expense and admission expense were reduced despite of age after telehealth services. The most common call-in problems was nursing consultation. The most common problem of nursing consultation was for care feeling. The telehealth care system can help cardiovascular patients to control blood pressure and sugar. It significantly decreased length of hospital stay and saving medical expense.

並列關鍵字

aging and low-birth-rate ； platforms of telehealth ； total medical expense ； admission expense ； admission rate ； hospital stay

參考文獻

Hsu TP, Chuang1 PY, Ho YL. The Application of Telehealth Care for Patients with Cardiovascular Diseases. Formosan J Med 2011;15:157-63

Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. Lancet 2011; 378: 731–39

Abraham WT, Adamson PB, Bourge RC, et al, for the CHAMPION Trial Study Group. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658–66.

Blumenthal D. Stimulating the Adoption of Health Information Technology. N Engl J Med. 2009;360:1477-9.

Chang HL, Shaw MJ, Lai FP, Ko WJ, Ho YL, Chen HS, Shu CC. U-health: an example of a high-quality individualized healthcare service. Personalized Medicine 2010; 7:677-688