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研究生:戴志江
研究生(外文):Chih-Chiang Tai
論文名稱:兒童氣喘與醫療資源利用
論文名稱(外文):Pediatric asthma and medical resources utilization
指導教授:李英俊李英俊引用關係
指導教授(外文):Ying-Chun Li
學位類別:碩士
校院名稱:國立中山大學
系所名稱:醫務管理研究所
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
語文別:中文
論文頁數:45
中文關鍵詞:氣喘醫療資源
外文關鍵詞:asthmamedical resources
相關次數:
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Background

氣喘兒童通常比非氣喘兒童使用較多的醫療資源,但是與氣喘相關的併發症發生率和醫療資源耗用之間的研究卻少見。

Methods

擷取2004年國家衛生研究院「全民健保學術研究資料庫」之『承保抽樣歸人檔』,該年度內所有門診主診斷碼(ICD-9-CM)為493,且年齡在1~18歲之氣喘病患,對氣喘相關的併發症發生率及醫療成本與資源耗用進行統計分析。

Results

共擷取門診394197人次,氣喘兒童7627人次,男性占62.5%,氣喘兒童併發過敏性鼻炎是非氣喘兒童的8.2倍,氣喘兒童併發異位性皮膚炎是非氣喘兒童的2.1倍,氣喘兒童併發中耳炎是非氣喘兒童的1.3倍,氣喘兒童併發鼻竇炎是非氣喘兒童的1.5倍。在醫療成本平均支出上,氣喘兒童大於非氣喘兒童( NT$ 11539 ± 10065 VS. 4557 ± 21032; P < 0.0001 )。而以病患分組方式分成四組檢定醫療成本支出,非氣喘兒童無併發症者( NT$ 3714 ± 24538 ),非氣喘兒童有併發症者( NT$ 6448 ± 8880 ),氣喘兒童無併發症者( NT$ 7396 ± 6434 ),氣喘兒童有併發症者( NT$ 12708 ± 10585 ),四組檢定醫療成本支出結果呈現統計差異( P < 0.0001)。醫療資源使用有七成看小兒科醫師,有四成在基層診所,有五成在北部地區。

Conclusion

氣喘兒童的醫療費用及共病發生明顯大於非氣喘兒童,醫療費用在氣喘兒童中合併有共病發生的兒童比沒有發生共病性的兒童來得高。基層小兒科醫師在兒童氣喘照護占有重要角色。
Background

Children with asthma usually use more medical resources than those without asthma. However, studies on the relationship between ratios of asthma-related complications and consumption of medical resources are rare.

Methods

We sampled data from “Registry for beneficiaries” of “National Health Insurance Research Database”, National Health Insurance Institute, 2004. The target group was patients, aged between 1 and 18 years old, whose main diagnosis number from outpatient department (ICD-9-CM) is 493. Ratios of asthma-related complications and consumption of medical costs and resources were submitted to statistical analysis.

Results

Data of 394197 outpatients, of whom 62.5% are males, were included. Among the entire sample, 7627 children have asthma. Children with asthma are 8.2 times likely to get allergic rhinitis than those without asthma. Children with asthma are 2.1 times likely to get atopic dermatitis, 1.3 times likely to get otitis media, 1.5 times likely to get sinusitis than those without asthma. With regard to average expenditure on medical treatment, that of children with asthma is higher than that of children without asthma. Expenditures on medical treatment are compared among four divided groups. Children without asthma or complications ( NT$ 3714 ± 24538 ) , Children without asthma having complications ( NT$ 6448 ± 8880 ) , children with asthma not having complications ( NT$ 7396 ± 6434 ) , children with asthma having complications ( NT$ 12708 ± 10585 ) . Results of expenditures on medical treatment among these four divided groups show statistically significant. Seventy % of medical resources utilized are pediatrics, 40% are clinics, 50% are in the northern area.

Conclusion

Ratio of comorbidities of children with asthma is obviously higher than that of children without asthma. With regard to medical costs, that of children with asthma having comorbidities is higher than that of children with asthma not having comorbidities. Therefore, local pediatricians have an important role in the care of children with asthma.
中文摘要 1
英文摘要 2
第一章 緒論 3
第一節 研究背景 3
第二節 研究動機與假設 4
第二章 文獻探討 5
第一節 氣喘的盛行率 5
1.1 國際上的氣喘盛行率 5
1.2 台灣的氣喘盛行率 5
第二節 氣喘的診斷 7
2.1 氣喘的臨床症狀 7
2.2氣喘的診斷方法 7
2.2.1 病歷記錄 7
2.2.2 理學檢查 7
2.2.3 實驗室檢查 8
第三節 氣喘嚴重度的分級 10
第四節 氣喘的治療目標 12
第五節 氣喘的危險因子 14
第六節 氣喘的免疫病理反應 15
第七節 氣喘的疾病管理與醫療資源使用 16
第八節 氣喘與過敏性疾病關係 18
第三章 研究方法 21
第一節 研究架構 21
第二節 研究資料來源 22
第三節 研究對象與資料串聯 23
第四節 研究設計 24
第五節 操作性定義 26
第三節 資料處理及統計方法 29
第四章 研究結果 30
第一節 門診氣喘兒童基本分析 31
第二節 氣喘兒童門診共病症分析 33
第三節 氣喘兒童住院資源分析 37
第五章 討論 38
第六章 結論 39
References 40
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