軍方及非軍方醫院的權屬別特性與肺炎病人於住院期間死亡之關係探討

Comparisons of Inpatient Mortality of Pneumonia Patients between Military and Non-military Hospitals

朱峻賢(Chun-Hsien Chu)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00054

摘要

軍人在2001年3月1日納入全民健保後，使得軍方醫院原有的病患逐漸傾向至非軍方醫院就診，探究原因大多因為病患對軍方醫院原有的印象不佳所致，但是有關軍方與非軍方醫院間醫療品質差異的研究仍付之闕如。雖然民眾可透過健保局網頁查詢各醫院有關糖尿病等六項疾病之醫療品質資訊，卻不包含照護結果面的醫療品質資訊。
本研究係以全民健康保險研究資料庫為資料來源，以肺炎住院病人的照護結果作為醫院的醫療品質指標，並依研究目的區分醫院權屬別為軍方醫院、公立非軍方醫院、私立醫院及財團法人醫院等四類。本研究並將病患特質（如年齡、性別等）、臨床特質（如合併症指數及呼吸器使用等）及照護提供者特性（如醫院層級、醫院地區別、醫院/醫師服務量及就醫科別等）等因素列為控制變項，以進一步分析軍方醫院的醫療品質與其他非軍方醫院間是否有顯著性的差異。
本研究使用2006年至2007年全民健康保險資料庫之住院醫療費用清單明細檔、醫事機構基本資料檔及重大傷病證明明細檔，選取肺炎住院之病人為研究對象，並採用邏輯斯蒂廻歸模式，以分析軍方及非軍方醫院的權屬別特性對於肺炎病人於住院期間是否死亡的影響力。
整體而言，本研究發現，軍方醫院在肺炎病人的住院照護結果上較非軍方的公立醫院佳，與私立醫院之間無顯著的差異，而較財團法人醫院差。此外，病患特質、臨床特質或照護提供者特性等因素，對於肺炎病人於住院期間是否死亡均有顯著性的影響力。
軍方醫院所提供之健康照護的成效儼然已達相當之水準，一般民眾或軍人在選擇就醫醫院時，應可信任軍方醫院的醫療品質，並接受其提供健康照護，以避免捨近求遠卻未能獲得較佳的醫療品質進而延誤病情的情形。醫院、病患本人或家屬在肺炎治療過程中，應特別注意病患是否具有較高的死亡風險，並採積極治療與健康管控的方式，以獲得較佳的照護結果。
本研究的限制研究為次級資料運用時，許多干擾因素無法取得（例如：醫療利用情形），建議未來研究者可在後續研究中加入生活品質等相關層面的研究議題。最後，本研究依據分析結果，提出下列幾項建議給予衛生主管機關參考：（1）將高度傳染性疾病病患的資料建置個案資料庫加以管理。（2）規劃肺炎相關疾病之專責醫院時，應以區域醫院或地區醫院為主。（3）針對高死亡風險族群擬訂相關預防政策。

關鍵字

醫院權屬別 ； 軍方醫院 ； 住院死亡 ； 醫療品質 ； 醫療品質指標 ； 肺炎

並列摘要

Military health care encompasses a diverse range of programs and has been included into the National Health Insurance program since March 1, 2001. The phenomenon results in an increasing number of patients in military hospitals shifting to non-military hospitals, mostly because of poor impressions of patients regarding military hospital services. However, research on the differences of medical care quality between military and non-military hospitals is still lacking. Although patients could check quality of medical care of the six specific diseases (including diabetes) through the National Health Insurance Bureau website, there is short of information of medical care outcome of military hospitals.
Utilizing the National Health Insurance Research Database of the study, the purpose of the study is aimed to compare inpatient mortality of pneumonia patients between military and non-military hospitals. For the study, the hospitals were classified as military hospitals, public non-military hospitals, private hospitals and for-profit hospitals. And control variables were patient characteristics (such as age and gender), clinical characteristics (such as the comorbidity index and use of ventilator) and care provider characteristics (such as hospital level, hospital location, service volumes of hospital physicians and clinical specialty).
Results indicated medical care quality for pneumonia patients of military hospital was better than that of non-military public hospitals, with no significant difference to private hospitals, but was relatively poor compared with that of for-profit hospitals. And, patient characteristics, clinical characteristics, characteristics of care providers all exerted significant influences on medical outcome of pneumonia patients.
Efficacy of health care provided by military hospitals has reached a rather good level currently. Therefore, if the general public or military soldiers are encouraged to choose military hospitals if it is more convenient for them when health care needs occur. Regarding the treatment of pneumonia patients, hospitals, patients themselves and their family members should pay particular attention to patients, and use aggressive treatment and health management approach for better medical care outcome.
The limitation of the study is that secondary data source was used, and therefore many confounding variables (such as healthcare utilization) could not be taken into account. It is recommended that in the future researchers should investigate the topic of quality of life and other related issue. Finally, it is recommended that (1) health authorities should establish a database of patients with highly infectious diseases to facilitate long-term tracking of those patients. (2) Local and area hospitals are responsible for pneumonia. (3) Preventive policy should be made to those with high risk of death. Such information could not only be used for future research, but also for disease management.

並列關鍵字

Hospital ownership ； Military hospital ； Inpatient mortality ； Healthcare quality ； Healthcare quality indicators ； Pneumonia

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