復健醫療服務之疾病分類研究：國內某醫學中心近期經驗

Primary Reasons for Rehabilitation Service Referrals: The Recent Experience of a Medical Center in Taiwan

蘇宗柏(Chung-Po Su) ； 陳思遠(Ssu-Yuan Chen) ； 王亭貴(Tyng-Guey Wang) ； 王顏和(Yen-Ho Wang) ； 連倚南(I-Nan Lien)

《台灣復健醫學雜誌》 38卷4期 (2010/12) Pp. 229-236

https://doi.org/10.6315/2010.38(4)04

摘要

目的：爲了進一步地瞭解當前復健醫療服務的對象與內容，我們進行以下研究：調查國立臺灣大學附設醫院的復健醫療服務的情況與疾病分類，以此單一醫學中心之經驗，探討接受復健醫療的主要疾病分類情況，並探討最近這十餘年來的復健醫療服務變化以及未來可能趨勢。方法：本回溯性的研究從國立臺灣大學附設醫院的資訊系統收集自2007年6月至2007年10月期間，接受門診及住院（包括照會）復健醫療之病患（4,305新病人及12,163複診病患，以及1,345位於此期間住院（包括復健科病房以外之全院病患）並接受復健醫療服務的病患）。根據世界衛生組織的國際疾病分類編碼修正第九版(International Classification of Diseases, ICD9CM)，將病人的疾病分類分爲12類：肌肉骨骼及軟組織疾病、腦部疾病、脊髓疾病、周圍神經病變、肌病變、骨折及截肢，語言障礙、心血管疾病、呼吸系統疾病、燒傷、癌症，及其它未分類。結果顯示：接受門診復健醫療之病患族群中以45至64歲組的患者比例最高（佔33.4%）；然而門診新病患中最高比例則是在15至44歲組（佔34.8%）。住院接受復健醫療服務之病人中，比例最高的是大於65歲組（佔44.9%）。疾病分類而言：肌肉骨骼及軟組織疾病（總門診人次的49.5%；新病人的67.6%）腦部疾病(25.4%)和語言障礙(8.1%)爲門診復健醫療服務前三名最常見的原因。然而，單就門診新病患而言語言障礙的比例高於腦部疾病是第二位。但腦部疾病(33.8%)、癌症(14.4%)及心血管疾病(12.3%)卻是前三名院內住院期間接收復健照會醫療服務的主要原因。結論：和以前的研究互相比較分析令我們注意到在住院期間接收復健照會醫療服務的癌症病患比例增加，且門診復健服務方面腦部疾病及語言障礙病患比例亦增加不少比重。老年人及兒童病人的比例也大幅增加。這些趨勢可提供我們健康醫療部門或醫院更瞭解復健醫療服務的實際情形，並提供更佳的服務。

關鍵字

復健 ； 疾病 ； 分類 ； 國際疾病分類 ； 照會

並列摘要

Objectives: To better understand the current utilization of rehabilitation services and to project future trends, this study investigated the primary reasons for rehabilitation services referrals in a medical center in Taiwan. Methods: We reviewed records of those patients who visited rehabilitation clinics (4,305 new and 12,163 returned patients) or received a rehabilitation consultation during their hospital stay (1,345 patients) between June and October 2007 at the National Taiwan University Hospital. The primary diagnoses of study patients were classified into 12 groups: musculoskeletal and soft tissue diseases, brain diseases, spinal cord diseases, peripheral neuropathy, myopathy, fractures and amputations, language disorders, cardiovascular diseases, respiratory system diseases, burns, cancer, and other. Results: Patients in the 45 to 64-year-old age group accounted for 33.4% of outpatient clinic visits; however, the 15-44 year-old group accounted for the most (34.8%) new outpatient clinic visits. The aged group greater than 65-year-old accounted for 44.9% of inpatient rehabilitation services. Musculoskeletal and soft tissue diseases were the most common reason for outpatient rehabilitation service visits (49.5% of total outpatient clinic visits and 67.6% of new clinic visits), followed by brain diseases (25.4%) and language disorders (8.1%). For new clinic visit outpatients, language disorders surpassed brain diseases as the second most common group. In contrast, brain diseases (33.8%), cancer (14.4%), and cardiovascular diseases (12.3%) were the top 3 reasons for physiatric consultation during inpatient care. Conclusions: In comparison with a previous study, we observed an increase in referrals regarding cancer for physiatric consultations during hospitalization and also an increase in referrals for brain diseases and developmental and language disorders to outpatient rehabilitation services. The proportions of elderly and pediatric patients increased as well. It is important that healthcare providers understand these trends in order to better serve our rehabilitation patients.

並列關鍵字

rehabilitation ； disease ； classification ； International Classification of Diseases ICD ； consultation