臺灣博碩士論文加值系統

在高年齡化的社會，對於老年人的醫療服務費用已逐漸成長釵h，而其中以慢性疾病為主要醫療服務費用的來源。一旦流行性感冒(流感)大流行時，對於老年人而言，將會因感染流感而引起嚴重的相關疾病的罹患與惡化住院，而間接造成的醫療給付費用也是相當可觀。
了解老年人在接種流感疫苗與否的情況下，其相關疾病的醫療給付費用的變化是值得討論的議題。因此，我們提出決策分析模式來評估其醫療給付費用的變化。影響圖(influence diagram)，為決策分析模式，其提供簡單的圖形方式來建構專家的知識。在不確定情況下，藉由影響圖可以臨床導向的方式進行推論，且過程可結合臨床檢驗結果與醫師的專業知識。因此，我們將從文獻資料與醫師訪談，以流感疾病與慢性阻塞性肺疾病(COPD)兩主要影響因素，建立模式以及評估接種流感疫苗的效益與找出最大的影響因素。研究對象主要以65歲以上老年人進行分析，並劃分成65-69歲、70-74歲、75-79歲、85歲以上的不同年齡層進行探討。
研究結果顯示，對於65歲以上的老年人而言，在接種流感疫苗下，與流感相關疾病的醫療給付費用比沒有接種者的醫療給付費用高於平均每人100元以上。其中影響醫療給付費用最大的是在不同狀況下的COPD的惡化住院，之後依序為不同狀況下的COPD的門診治療與感染流感。在不同的年齡層下，在接種流感疫苗下，與流感相關疾病的醫療給付費用仍高於沒有接種流感疫苗者的醫療給付費用，但隨著年齡層增加，兩者間的醫療給付費用差距有遞減的狀況。因此對於年紀愈大的老年人，接種流感疫苗的效益愈明顯，醫療給付費用也明顯減少。

Taiwan has become an aging society. The cost of medical service expense for the elders gradually has gone up a lot. The elders with chronic diseases have become the main source of medical service expenditure. Once the influenza virus is prevalent, the virus will cause serious the morbidity of and hospitalization of related diseases owing to influence infection for the elders, and then medical expense will be very considerable.
It is a worthy issue to understand the variation of health expenditure of related diseases that the elders are suffered whether they receive vaccine or not. We address the decision analysis model to estimate the variation of health expenditure. An influence diagram, a decision analysis model, provides a simple graphical skill to construct the knowledge of experts. The decision could be clinically oriented to reason by an influence diagram under uncertain condition. And decision process can incorporate clinical results and the knowledge of physicians by an influence diagram. Therefore, we focus on two factors of influenza and Chronic Obstructive Pulmonary Disease (COPD) from studying the related literature and discussing with physicians, and then we create a model to estimate benefits of influenza vaccination and to find out the most influential factor for persons aged 65 and over 65 years, dividing into groups of aged 65-69, 70-79, 80-84, 85 and over 85.
For the elderly aged 65 and over 65 years, the result shows that the expected health expenditure for receiving influenza vaccination are more than expenses for not receiving influenza vaccination, larger than NT$ 100 per person. The minimum expected health expenditure mostly affects the hospitalization of exacerbated COPD under the different condition. The follow is treatment of COPD, and influenza infection, in order. At each group of aged in the range, 65-69, 70-74, 75-79, 80-84 and 85 and over 85, the results shows that the minimum expected expenditure for receiving influenza vaccination is more than the expenditure for not receiving influenza vaccination. But there are trend of decreasing as the age is older. It is obviously to shows that the benefit of influenza infection is more valid for the older persons. And the health expenditure have become less obviously.

Chapter 1 Introduction 1
Chapter 2 Literature Review 4
2.1 Application of Decision Analysis for Medicine Domain 4
2.2 An Influence Diagram 6
2.2.1 Definition of an Influence Diagram 7
Chapter 3 The Construction of Model 12
3.1 Variables and Assumption of the Model 12
3.2 The Construction of the Influence Diagram Model 14
Chapter 4 Model Analysis and Assessment 21
4.1 Model Analysis 21
4.2 Model Assessment 30
Chapter 5 Conclusion and Research Limitation 41
5.1 Conclusion 41
5.2 Research Limitation and the Future Research Direction 42
Reference 43

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