Title

慢性病患者接受醫病共享決策對醫療耗用與醫療成效之影響 系統性文獻回顧與統合分析

Translated Titles

The Effec of Shared Decision Making on Medical Utilization and Healthcare Outcomes in Chronic Disease Patients:Systematic Review and Meta Analysis

Authors

李堃源

Key Words

醫病共享決策 ; 醫療資源耗用 ; 醫療成效 ; 醫療費用 ; 住院天數 ; 高血壓 ; Shared Decision Making ; Healthcare Outcome ; Medical Resource Use ; Medical Costs ; Length of Stay ; Hypertension

PublicationName

高雄醫學大學醫務管理暨醫療資訊學系碩士在職專班學位論文

Volume or Term/Year and Month of Publication

2020年

Academic Degree Category

碩士

Advisor

許弘毅

Content Language

繁體中文

Chinese Abstract

研究目的: 國內外許多研究對醫病共享決策對於醫療資源耗用及治療結果之影響意見分歧,因此本研究探討醫病共享決策對於慢性疾病患者在醫療費用與住院天數以及對日程活動、疾病認知與社會功能與高血壓病人收縮壓改變之影響。 研究方法: 本研究為回溯性研究,採用國外著名5大資料庫,搜尋2010-2020間電子資料庫、英文:醫病共享決策、醫療資源耗用、醫療成效、高血壓等關鍵字的搜尋策略,經PRISMA四階段的篩選流程,將合乎納入的文獻以統合分析軟體CMA3.0進行文獻的統合分析,結果分別以森林圖、漏斗圖呈現文獻統合結果及判斷有無文獻發表之偏差。 研究結果: 有21篇納入統合分析。其結果如下:1.有無接受醫病共同決策對慢性疾病患者總醫療費用是降低,但統計學上無顯著差異(d=-0.51, p=0.242)、會縮短住院天數,但統計學上無顯著性 (d=-0.215, p=0.073)。2.醫療成效面向,慢性病患者接受醫病共享決策:能提高日常活動功能評分,但統計學上無顯著性 (d=0.135, p=0.203)、在認知功能評分上會增加,且有統計學上顯著差異(d=0.745, p=0.041)、對高血壓患者有接受醫病共同決策在一年內收縮壓有下降,且有統計學上顯著意義(d=-0.277, p<0.05)。 結論與建議: 本研究結果證實接受醫病共享決策能明確降低高血壓病患收縮壓,提升病患對疾病識能、降低對疾病焦慮以及憂鬱;可能降低醫療費用、縮短住院天數、提升日常活動評分,但需更多文獻研究佐證。建議應繼續推行醫病共享決策,讓專責人員替代醫師擔任引導員,健保機關予以執行醫病共享決策案件補助。

English Abstract

Introduction Shared Decision Making can improve communication between healthcare providers and patients. However, it is not confimed that patients who received Shared Decision Makingin can reduce medcial resource utilization and improve healthcare outcomes. Thus, this study explored the effect of Shared Decision Making in medcial resource utilization and healthcare outcomes in chronic disease patients. Methord This is a systematic reveiew and meta-analysis study. We reviewed articles that were publicated from 2010 to 2020 with keywords: total medical use, healthcare outcomes, length of stay, the daily activeity function score, recognizatin function score, and systolic blood pressure in global five English data bases. We also follow PRISMA four-stage process to filter through our articles. The CMA 3.0 was employed for the meta-analysis. The forest graphy and funnel plot were used to explain the results of the maeta-analysis and we also conduct the publicated bias. Result A total of 21 articles were included in this study. The patients who received Shared Decision Making significantly decreased in systolic blood pressure (d=-0.277, p<0.05) and improved recognization function (d=0.745, p=0.041). Although total medical costs (d=-0.51, p=0.242), lengths of stay (d=-0.215, p=0.073) and daily activity function (d=0.135, p=0.203) showed an improvement, but there are not significantly statisticant. Conclusion The Shared Decision Making will significantly decrease systolic blood pressure and improve recognization function among chronic disease patients. Total medical costs, lengths of stay and daily activity function showed few improvements. More articles were needed to confirm the result.

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學院 > 醫務管理暨醫療資訊學系碩士在職專班
社會科學 > 管理學
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