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研究生:吳宜玲
研究生(外文):Yi Ling Wu
論文名稱:腦中風影像診斷與後續醫療耗用相關性分析
論文名稱(外文):Relationship Between Imaging Diagnosis and Resource Utilization for Stroke Patients
指導教授:王惠玄王惠玄引用關係
指導教授(外文):H.I. Wang
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
論文頁數:67
中文關鍵詞:腦中風影像診斷醫療耗用
外文關鍵詞:strokeimaging diagnosisresource utilization
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近二十年來,由於醫療服務與診斷工具的進步,歐美各國將影像診斷工具電腦斷層攝影(CT)及核磁共振掃瞄(MRI)納入腦中風臨床指引,藉以提升醫療照護品質以及病人安全。本研究以腦中風病患為對象,探討臨床指引中影像診斷工具-電腦斷層攝影(CT)及核磁共振掃瞄(MRI)使用比率及診斷工具的使用與後續醫療耗用之關係。
本研究運用全民健康保險資料庫2001至2004年承保抽樣歸人檔,以疾病分類號出現「腦血管疾病」者(ICD-9-CM為430-437)定義為腦中風病患,並以治療期為單位檢視腦中風病患在治療期間內之醫療耗用,合計4,423個治療期(3,297人)。分析結果發現,腦中風病患在就醫治療期中有接受影像診斷CT/MRI佔44%。接受檢查時間以住院期間檢查者佔45%最多,以醫學中心執行CT/MRI比率最高約44%。利用t檢定分析,接受CT/MRI者其平均疾病嚴重度為5分高於無接受CT/MRI者2分(P<0.01);有接受CT/MRI者其平均門、急診次數為33次,高於無接受CT/MRI者18次(P<0.01);在平均門、急診申報費用及平均住院費用上,接受CT/MRI均高於無接受CT/MRI,其差異達統計上顯著意義(P<0.01)。
複迴歸分析發現,有使用CT/MRI者相對於沒有使用CT/MRI者,其門、急診次數多3.69次,門、急診費用多5倍,不含CT/MRI之門、急診費用多3.8倍,住院日數多0.3天,住院費用多2.3倍,不含CT/MRI之住院費用多2.2倍,不含病房費之住院費用高2.1倍,不含CT/MRI與病房費之住院費用高1.4倍,總醫療費用高14倍。
由本研究之結果,建議醫療院所,適時提供醫療相關醫師對於腦中風診斷之教育訓練,尤其在第一時間能迅速評估是否立即給予CT/MRI之檢查;建議後進研究者可挑選腦中風相關之就醫資料進行分析,並使用固定時間作為費用之計算期間,可嘗試加入併發症與是否手術等變項予以控制,最後,若能有明確之預後結果,藉以評估執行CT/MRI之成效,亦能顯現出CT/MRI之重要性。
Because of the progress of medical care and diagnostic tools in the past 20 years, every countries take imaging diagnostic tools, like computer Tomography (CT) and magnetic resonance image (MRI), into the stroke clinical guideline. It can improve the quality of medical treatment and patient safety. This research takes stroke patient as the subject to understand the using rate of CT/MRI and the relationship between resource utilization and CT/MRI.
This study uses the claims data of health insurance database from 2001 to 2004. ICD-9-CM with code from 430 to 437 is selected from panel database. There are 4,423 episodes (3,297 people) which are defined as a unit during the treating in this study. The major results of this study are as follow:
The using rate of CT/MRI is about 44%. There are 45% stroke patients take the CT/MRI when they are in hospital, and about 44% use in the medical center. Using t test for analysis, the average disease severity in patients who accepted CT/MRI was 5 which is higher than the patients who don’t accepts CT/MRI is 2 (P<0.01). The patients who accepted CT/MRI have average 33 times in outpatient department and emergency room higher than the patient who don’t accepts CT/MRI 18 times (P<0.01). The average expenses in OPD, ER and IPD is higher than not accepting CT/MRI to accept CT/MRI, difference its reach count, showing meaning (P<0.01) .
By regression analysis, there are something be found .Comparing with patients who don’t use CT/MRI, the patients have 3.69 more of the number of OPD and ER visits, 5 times of OPD and ER expenses, 3.8 times of OPD and ER expenses except CT/MRI, 0.3 more of LOS, 2.3 times of IPD expenses, 2.2 times of IPD expenses except CT/MRI, 1.4 times of IPD expenses except CT/MRI and room fee, 14 times of total expenses.
According to this research, we suggest that the hospital could provide education of stroke diagnosis for doctors especially to evaluate whether or not to use CT/MRI on time. Future researches could choose the data which is relation with stroke and control the length of episode. Try to increase the complications and operation on control variables. Finally, it is better that data have outcome to evaluate the CT/MRI on stroke patients.
目 錄
指導教授推薦書
口試委員會審定書
長庚大學博碩士論文著作授權書 III
誌謝..... IV
中文摘要 V
ABSTRACT VI
第壹章 緒論 - 1 -
第一節 研究背景與動機 - 1 -
第貳章 文獻探討 - 3 -
第一節 腦中風 - 3 -
第二節 腦中風相關病人安全議題 - 4 -
第三節 腦中風臨床指引與臨床診斷 - 5 -
第四節 腦中風醫療費用相關因素 - 10 -
第五節 文獻總結 - 13 -
第三章 研究方法 - 14 -
第一節 問題與假說 - 14 -
第二節 研究材料及對象 - 16 -
第三節 研究變項 - 19 -
第四節 統計分析方法 - 23 -
第四章 研究結果與討論 - 24 -
第一節 研究對象基本特性分析 - 24 -
第二節 腦中風病患CT/MRI使用與醫療耗用分析 - 29 -
第五章 結論與建議 - 45 -
第一節 結論 - 45 -
第二節 建議 - 46 -
第三節 研究限制 - 47 -
參考文獻 - 48 -
附錄一 研究資料來源和使用之欄位 - 53 -
附錄二 電腦斷層造影與MRI之健保醫療費用支付標準 - 54 -
附錄三DEYO (1992)之CHARLSON COMORBIDITY INDEX與ICD9-CM對照表 - 55 -



圖表目錄
圖1 研究架構……………………………………………….- 16 -
圖2 資料處理流程………………………………………….- 18 -
表4-1 腦中風病患基本特性,2001-2004…………………… - 26 -
表4-2 腦中風病患接受CT/MRI之醫療機構層級與就醫類別,2001-2004……………………………………………… - 27 -
表4-3 腦中風病患門、急診及住院服務使用,2001-2004… - 29 -
表4-4 腦中風病患CT/MRI使用與門、急診及住院使用T檢定,2001-2004……………………………………………… - 31 -
表4-5 腦中風病患CT/MRI使用與刪除5%上限極端值門診及住院醫療利用之T檢定,2001-2004……………………… - 32 -
表4-6 腦中風患者CT/MRI使用與門、急診費用對數之複迴歸分析,2001-2004………………………………………… - 34 -
表4-7 腦中風患者CT/MRI使用與門、急診費用(未含CTMRI費用) 對數之複迴歸分析,2001-2004……………………… - 34 -
表4-8 腦中風患者CT/MRI使用與門、急診次數之複迴歸分析,2001-2004………………………………………………- 35 -
表4-9 腦中風患者CT/MRI使用與住院費用對數之複迴歸分析,2001-2004……………………………………………… - 37 -
表4-10 腦中風患者CT/MRI使用與未含CT/MRI費用之住院費用對數複迴歸分析,2001-2004…………………………… - 38 -
表4-11 腦中風患者CT/MRI使用與未含病房費之住院費用對數複迴歸分析,2001-2004…………………………………… - 39 -
表4-12 腦中風患者CT/MRI使用與未含CTMRI與病房費之住院費用對數複迴歸分析,2001-2004……………………… - 40 -
表4-13 腦中風患者CT/MRI使用與住院日數之複迴歸分析,2001-2004………………………………………………- 41 -
表4-14 腦中風患者CT/MRI使用與住院次數之複迴歸分析,2001-2004……………………………………………… - 42 -
表4-15 腦中風患者CT/MRI使用與醫療總費用對數之複迴歸分析,2001-2004……………………………………………… - 43 -
表4-16 出血性腦中風病患基本特性,2001-2004 ……………- 44 -
表4-17 出血性腦中風病患接受CT/MRI之醫療機構層級與就醫類別,2001-2004………………………………………… - 44 -
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