活動性肺結核病人之共病與住院天數及健保費用之探討

Influence of active tuberculosis comorbid with other diseases on days of hospitalization and health insurance costs

劉雅絃(Ya-Hsien Liu) ； 翁紹仁(Shao-Jen Weng) ； 潘忠煜(Chung-Yu Pan) ； 劉士嘉(Shin-Chia Liu) ； 黃惠美(Hui-Mei Huang) ； 陳俊朋(Jun-Peng Chen)

《醫務管理期刊》 21卷2期 (2020/06) Pp. 93-110

https://doi.org/10.6174/JHM.202006_21(2).93

摘要

目的：肺結核是臺灣最常見也是死亡率最高的法定傳染病，具傳染性的肺結核病人，必要時需接受長時間住院隔離治療，本文藉由統計分析探討肺結核與共病相關性。本研究主要為探討活動性肺結核病人合併共病、痰塗片結果，以及影響住院天數及健保費用的相關因素。方法：以某醫學中心臨床資料庫2014年6月1日至2017年6月30日的活動性肺結核病人為對象共221人，進行病歷資料的收集，應用SPSS軟體統計分析，連續資料以獨立樣本t檢定（Independent t-test），不同共病組間之比較類別資料以卡方檢定（Chi-square test），三組以上資料則以變異數分析（ANOVA）及事後檢定使用Bonferroni test，並以卜瓦松迴歸（Poisson regression）分析相關因素。結果：發現活動性肺結核病共病紅斑性狼瘡者，其住院天數、健保費用有顯著差異；合併三種以上共病含有糖尿病時，其住院天數有顯著差異。病人的年齡、性別、痰塗片結果及合併共病，為影響住院天數及健保費用的相關因素。結論：肺結核病人合併共病及痰塗片陽性較嚴重者，因為需要更長的時間控制疾病及感染症狀，故住院天數較長，健保費用較高，建議透過對肺結核相關知識及預防之宣導，提升民眾相關知能，尤其合併共病且免疫力弱的病人，應早期診斷早期治療，藉此提供預防保健、臨床照護及未來健保決策的參考。

關鍵字

活動性肺結核 ； 共病 ； 住院天數 ； 健保費用

並列摘要

Objectives: Tuberculosis is the most common statutory communicable disease in Taiwan and has the highest mortality rate. Patients with tuberculosis require long-term hospital isolation and treatment, which can cause physical and psychological discomfort and incur social and medical costs. The purpose of this study was to investigate the relationship of comorbidity with days of hospitalization and health insurance costs in patients with active tuberculosis, relationship of sputum smear findings and comorbidity with days of hospitalization in patients with pulmonary tuberculosis, and factors affecting days of hospitalization in patients with active tuberculosis. Methods: Medical records of 221 patients with active tuberculosis were collected from the clinical database of medical center for the period between June 1, 2014, and June 30, 2017. SPSS software was used for statistical analysis, and an independent -samples t-test was used for continuous data. Data of different groups of comorbidities were compared using a chi-square test. Data of three or more groups were analyzed using analysis of variance and post-mortem using the Bonferroni test; relevant factors were analyzed using Poisson regression. Results: Active tuberculosis comorbid with erythematosus lupus engendered significant increases in days of hospitalization and health insurance costs. Moreover, the presence of three or more comorbidities including diabetes resulted in a significant increase in days of hospitalization. Factors such as patient age, gender, sputum smear results, and comorbidities affected days of hospitalization and health insurance costs. Conclusions: When tuberculosis is comorbid with both lupus erythematosus and diabetes, controlling the disease is difficult because of immune diseases and infections. Patients with positive smear results for severe bacteria would require a longer time for the results to change to negative; therefore, their days of hospitalization would be longer. The results of this study can provide reference for making preventive health care, clinical care, and future health care decisions.

並列關鍵字

Active tuberculosis ； comorbidity ； days of hospitalization ； health insurance costs

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