醫療機構性質及醫師特質對我國氣喘兒童再入院之關係

Impact of Characteristics of Hospital and Physician on Re-admission of Children with Asthma in Taiwan

李信衛(Hsin-Wei Li)

指導教授 ： 郭乃文

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(2009年)

摘要

氣喘是兒童最常見的慢性疾病之一，而台灣近年來氣喘病童之住院率、重病率與致死率節節上升，有鑑於此，本研究嘗試找出醫療機構性質及醫師特質與氣喘兒童再入院的關係，給醫療提供者、使用者及衛生主管機關做為參考，進而改善我國氣喘兒童治療之成效。
本研究資料來源為全民健康保險資料庫(NHIRD)之住院醫療費用清單明細檔(DD file)、醫事機構基本資料檔(HOSB file)及醫事人員基本資料檔(PER file)，納入所有我國民眾於2001-2004年間入院之醫療紀錄，並加入兩項照護成效指標，分別為14天內再入院及30天內再入院。研究對象為我國18歲以下因氣喘住院之兒童，以卡方檢定(Chi-square test)分析自變項與依變項之相關性，並將達到顯著差異之自變項置入廣義估計方程式(Generalized Estimating Equations)，並加入控制變項，建立完整分析模式， 以檢驗醫療機構性質、醫師特質對氣喘兒童再入院之關係。
研究結果發現經由廣義估計方程式分析後，醫療機構性質中，部分醫院分局別對於我國兒童因氣喘14天內再入院次數有顯著相關，中區分局與台北分局皆較北區分局有較高的log OR，分別為0.63倍及0.41倍。而30天內再入院方面，特約類別及分局別除東區分局外皆與其呈現顯著相關，特約類別中log OR最高者為醫學中心相對於地區醫院之0.41倍；分局別則為台北分局相對於北區分局之0.52倍。經由醫師特質在方程式中之分析結果顯示，醫師年齡46-55歲組在14天及30天內再入院次數比較上皆達到顯著差異，其log OR分別為0.39倍及0.21倍。
本研究發現，醫療機構性質及醫師特質對於氣喘兒童之再入院風險於30天內再入院比14天內再入院有較明顯的差異性，表示氣喘之復發程度可能在30天內較14天內能看出前次住院的照護品質。而北區分局之14天及30天內因氣喘再入院次數風險均低於其他分局，顯示北區分局所涵蓋之地區擁有較佳之醫療條件或環境，或此區內之醫療機構擁有較佳之照護成效品質。最後，醫師年齡介於36-45歲之醫師相較於其他組，有較低的因氣喘再入院風險。

關鍵字

醫療機構 ； 醫師特質 ； 氣喘兒童 ； 再入院 ； 廣義估計方程式

並列摘要

Objectives: Asthma is a common chronic disease of children. In recent years, the prevalence asthma sick children, serious illness rate and mortality of asthma children in Taiwanese hospital raise steadily. Accordingly, this study tried to find out the impact of hospital and physician characteristics on re-admission of children with asthma. so that providers and health authority may use the information to improve treatment of asthma children in Taiwan.

Methods: The data was subtracted from DD file, HOSB file and PER file of National Health Insurance Research Database (NHIRD), including all medical records of Taiwanese who were admitted to hospital between 2001 and 2004. The researchers also included two indicators, readmission within 14 days and readmission within 30 days after discharged. Study objects were children under 18 who was admitted to hospital due to asthma. Chi-square tests were applied to analyze relationship between dependent variables and independent variables. Those dependent variables showed significant difference were included into the Generalized Estimating Equations. Control variables were also included to establish a full model to examine the relationship of hospital and physician characteristics and re-admission of children with asthma.

Results: Results of generalized estimate equation showed that, among hospital characteristics, there was a significant association between the jurisdiction regions of the Bureau of National Health Insurance (BNHI) and, number of readmission within 14 days for those children with asthma. Both the BNHI Central Branch and BNHI Taipei Branch have higher log OR than the BNHI Northern Branch; they are 0.63 times and 0.41 times compared with the Northern Branch respectively. Furthermore, it showed that, among hospital characteristics, there was a significant association between readmission within 30 days and levels of hospital accreditation, jurisdiction regions of the BNHI except Eastern Branch. The highest log OR is medical center which is 0.41 times compared with district hospitals in levels of hospital accreditation ,and Taipei Branch is 0.52 times compared with Northern Branch. Results of equation analyzing in physician characteristics showed that readmission within 30 days and within 14 days are significantly different in those physician whose age are between 46-55 years. Their log OR are 0.39 times and 0.21times respectively.

Conclusions: This study showed that, in terms of readmission of children with asthma, the characteristics of hospital and physician had more significant impact on those readmitted within 30 days than within 14 days. This may suggest that, from asthma recurrence, readmission of children with asthma within 30 days may be a better indicator regarding quality of previous hospitalization than 14 days. And the risk of re-admission due to asthma within jurisdiction of Bureau of National Health Insurance Northern Branch were lower than others, Which suggested that the jurisdiction of the BNHI Northern Region Branch may have better healthcare environment and then foster better quality of health care. Finally, those physicians whose ages were between 36-45 years tend to have lower risks of readmission due to asthma.

並列關鍵字

hospitals ； physician ； characteristics ； asthmatic children ； re-admission ； Generalized Estimating Equations

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