台灣主動脈瘤手術患者住院醫療資源利用－ 人口學基礎研究

研究背景及動機:主動脈瘤是常無症狀，卻可能是致命的隱形殺手，以人工血管置換主動脈是主動脈瘤主要的治療方式，現今國內對於主動脈瘤人工血管置換手術的醫療品質及醫療服務利用的研究甚為缺乏。本研究主要在分析探討影響主動脈瘤人工血管置換手術病人醫療服務利用的各項相關因素，以提升主動脈瘤手術病人醫療品質。研究方法：本研究採用次級資料的回溯性分析，以西元1996年至2010年間所有在台灣進行過主動脈瘤手術之病人為基礎，探討分析不同病人特質、機構特質對於當次手術後醫療服務資源利用以及醫療品質的影響。研究結果：本研究顯示主動脈血管置換手術盛行率長期趨勢有逐年上升情形，由1996年12例上升至2010年271例，男性>女性，但性別不影響醫療利用，而共病症的嚴重度(CCI≧1)及機構特質(醫院層級、醫師服務量) 對醫療利用則有所差異。主動脈瘤當次手術平均住院天數為26.55天，醫學中心為27.76天，地區及區域醫院為21.5天，住院醫療費用為424133元。有心衰竭及高血壓疾病者為增加住院天數之因子，而腎臟疾病者為增加住院醫療費用之因子。當次手術醫療品質方面，當次手術院內死亡率21.8% ，以男性佔多數，年齡61-80歲為最多。高血壓、心衰竭、低服務量醫院皆會增加當次手術院內死亡率。長期醫療品質方面，其平均存活月數為73.98±1.355個月，共病症的嚴重度(CCI)為術後死亡之影響因子，但手術機構不同對於長期存活不具影響。討論與建議：主動脈瘤手術病患盛行率逐年上升，且醫療資源利用佔全國健保醫療總費用的比例也增加，由研究中發現具腎臟疾病者有較高的醫療服務利用，而高血壓疾病對主動脈瘤病患長期存活有顯著的影響。在國人整體健康狀況日益提升之際，加強這兩類疾病患者的健康照護及慢性病的控制，才能減少醫療的耗用，降低醫療成本，進而獲得預期的成本效益及價值。本研究是採回溯性研究方式，建議未來可以採取縱貫性研究，收集臨床病患長期資料做趨勢分析並將門診費用納入研究變項，以瞭解其療效與術後醫療費用情形。

關鍵字

主動脈瘤手術；醫療服務利用；醫療品質

並列摘要

Background Aortic aneurysm is an usually asymptomatic but potentially fatal invisible killer. Aortic graft replacement is the main treatment for aortic aneurysm . Research about quality of care and medical service is lacking in Taiwan. Therefore, this study is to compare different factors that are relevant in quality of medical resource utilization. Methods This study retrospectively collected patients who received aortic aneurysm surgery with aortic graft replacement in Taiwan from 1996 to 2010.It is to compare the impact of different patient characteristics and hospital characteristics to the quality of care and medical resource utilization. Results The average length of hospital stay was 26.55 days, 27.76 days in medical center, and 21.5 days in other hospital. The average medical cost is 424133 NT. Heart failure and hypertension will increase the length of hospital stay and renal disease will increase the medical cost. The average hospital mortality rate is 21.8%. All of the hypertension, heart failure, low-volume hospital will increase the hospital mortality. Discussion and Conclusion Aortic aneurysm surgery is high-risk operation with high hospital mortality. Heart failure, hypertension, and low-volume hospital are the relevant factors to increase the hospital mortality and the renal disease is the only relevant factor to increase the total medical cost. Conclusions and Recommendations The prevalence of aortic aneurysm surgery patients increased year by year, and accounting for the use of medical resources, health care ratio of total health care costs also increased from the study found that those with kidney disease have higher health care utilization, and hypertensive disorders of aortic aneurysm patients have a significant impact on long-term survival. In occasion of the overall health of the people rising, the strengthening of these two types of patient health care and chronic disease control and provide comprehensive assessment and care, in order to reduce the incidence of aortic aneurysm disease, in order to reduce the consumption of health care, reduce health care costs ,, in order to obtain the expected cost-effectiveness and value. This study is a retrospective study collected manner, it is recommended to take future longitudinal studies, patients with long-term clinical data collected to analyze trends and outpatient costs variables included in the study in order to understand its efficacy and postoperative medical costs scenario.