外傷性脊髓損傷者使用健保資源秏用率及復健之介入初探

The Health Insurance Resources Utilization and Rehabilitation Intervention in Patients with Traumatic Spinal Cord Injury: A Pilot Study

黃寶(Pao Huang) ； 王仁宏(Jen-Hung Wang) ； 樊志成(Chih-Cheng Fan) ； 陳柏廷(Po-Ting Chen) ； 梁忠詔(Chung-Chao Liang)

《台灣復健醫學雜誌》 49卷2期 (2021/12) Pp. 173-182

https://doi.org/10.6315/TJPMR.202112_49(2).0004

摘要

脊髓損傷是一種對病患本身及健保醫療造成長期醫療負擔的疾病。隨著醫療技術進步，脊髓損傷患者死亡率降低，且因為台灣人口平均餘命延長，伴隨失能存活的脊髓損傷患者，需要長期復健治療及應付各種後續併發症，長期照護需求的費用也可預期地將會再增加。本研究的目的在分析外傷性脊髓損傷病患在住院時及出院後追蹤三年健保醫療費用的影響因子，以期望能更有效的運用醫療資源。本研究收集分析健保資料庫的百萬歸人檔，於2000年到2009年並持續追蹤三年到2012年，計有5652位外傷性脊髓損傷，符合ICD-9分類碼806.XX及952.XX者。病患的基本資料包括年齡、性別、受傷原因、住院天數、是否合併六大外傷、復健使用次數、再次入院次數及天數等醫療費用相關的因子皆被納入，再以複迴歸分析各變項之影響。分析結果顯示，平均住院費用為96246 ± 142451元，平均住院天數則為10.4 ± 25.3天。而與健保醫療耗用相關的顯著因子，包含：（1）年齡、（2）性別、（3）受傷部位、（4）是否合併外傷及（5）三年內再次住院次數。本研究顯示下列幾項數據，年紀越大，因意外發生造成的TSCI比率逐漸提高，尤其女性在超過60歲之後，發生比率相對顯著。患者若合併六大外傷，以頭部創傷達14.9%佔最大宗。而在住院時有接受復健治療的只佔17.9%，而其中職能治療介入更少，只有5.6%。為減少失能且預防併發症的發生，能及早接受復健治療的介入，可以衛教家屬減少關節攣縮、褥瘡的發生或其他併發症所造成照護上的困擾。

關鍵字

脊髓損傷（spinal cord injury） ； 復健治療（rehabilitation） ； 健保資料庫（national health insurance research database）

並列摘要

Spinal cord injury is associated with a substantial and long-term economic burden on both the patients and the national health insurance. Due to the advancements in medical techniques, the mortality rate of patients with spinal cord injury has decreased. Moreover, as the life expectancy has increased in Taiwan, patients with spinal cord injury may need long-term rehabilitation to restore their functions of daily living and prevent further complications. Nonetheless, long-term rehabilitation would increase the economic burden on the long-term care facilities, as expected. This study aimed to analyze the impact (from admission to 3-year follow-up after discharge) of medical expenses on patients with traumatic spinal cord injury, with a focus on using the medical resources more efficiently. In this study, data from the National Health Insurance Research Database was analyzed and 5,625 patients with traumatic spinal cord injury (ICD-9 classification cord 806.XX and 952.XX) between 2000 and 2009 (follow-up to 2012) were finally included. The extracted data included age, gender, cause of injury, duration of inpatient hospital stay, presence of other traumatic injuries, duration of rehabilitation, total number and duration of readmissions, and other variables that might have an impact on the medical expenses. Multiple regression analysis was performed to ascertain the effects of the variables. The results showed that the average hospitalization expenses were 96,246 ± 142,451 dollars, and the average duration of the inpatient hospital stay was 10.4 ± 25.3 days. In addition, the variables, that had a significant impact on the utilization of the health insurance included age, gender, site of injury, presence of other traumatic injuries, and the number of readmissions during the 3-year follow-up period. The results showed that patients using more health insurance and economic resources had some specific characteristics, including male aging from 40 to 60, cervical spinal cord injury, and receiving rehabilitation. Female aging more than 60 were more likely to suffer from traumatic spinal cord injury (TSCI) causing by accidents. Moreover, head injury was the commonest traumatic injuries combining with TSCI (14.9%). Only 17.1% and 5.6% patients with TSCI received inpatient rehabilitation and occupational therapy, respectively.

並列關鍵字

spinal cord injury ； rehabilitation ； national health insurance research database

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