跳到主要內容

臺灣博碩士論文加值系統

(3.229.142.104) 您好!臺灣時間:2021/07/30 15:25
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:鄭浩任
研究生(外文):Hao-Jen Cheng
論文名稱:老年髖骨骨折之兩種主要型態其術後住院天數及醫療耗用之比較
論文名稱(外文):The Comparison of Length of Hospital Stay and Expenditure of Two Major Hip Fracture Patterns in Elderly Patients
指導教授:蘇 喜
指導教授(外文):Syi Su
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫療機構管理研究所
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:2009
畢業學年度:97
語文別:中文
論文頁數:63
中文關鍵詞:髖骨骨折股骨粗隆股骨頸醫療費用
外文關鍵詞:hip fracturefemoral pertrochanterfemoral neckcost
相關次數:
  • 被引用被引用:4
  • 點閱點閱:486
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
髖骨骨折常發生於老年病患,且容易造成永久失能,帶給社會及家人沉重的負擔。超過百分之九十的老年病患髖部骨折都是跌倒所造成的,隨著年紀增高以及所伴隨的骨質疏鬆症,跌倒造成骨折的機率也愈大。髖部骨折型態可分為二大類:股骨頸骨折及股骨粗隆周圍骨折。股骨頸骨折在高齡病患中常以人工股骨頭置換術治療,股骨粗隆周圍骨折原則上均是以鋼釘固定患處,使骨折處可以逐漸癒合。
本研究追蹤2005年間於台大醫院雲林分院因髖骨骨折接受手術治療的病患,經由病例回顧及電話訪問,收集病患的各項資料及住院醫療費用清單,分析不同髖骨骨折型態間病患特質的差異以及其與住院天數、住院期間所耗費的醫療資源的影響,希望找出影響住院天數及醫療費用的因素,期能藉此找出減少住院天數及醫療資源的耗用的方法。
Hip fractures are commonly seen in the elderly and may result in permanent disability and enormous burden to the society and family. More than 90% of the hip fractures in the elderly caused by a fall, and the risks of the fall related fractures increased as the aging process and the accompanying osteoporosis. There are two major hip fracture patterns: the femoral neck fractures and the femoral pertrochanteric fractures. Displaced femoral neck fractures in the elderly are most often treated with hemiarthroplasty, while femoral pertrochanteric fractures are treated with open reduction and internal fixation of the fracture site.
In this study we recruit the patients receiving primary surgical intervention for hip fractures in 2005 at the National Taiwan University Hospital Yunlin Branch. The demographic data and the cost during the hospital days for each patient were collected via chart review and telephone contact. The differences between the two major hip fracture patterns and their influences to the length and cost of hospital days were then analyzed. We are looking forward to find out the factors that influence the hospital days and the cost of the patient who suffered from hip fractures.
口試委員會審定書 i
謝詞 ii
中文摘要 iii
Abstract iv
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究目的 2
第二章 文獻探討 3
第一節 跌倒與骨質疏鬆症 3
第二節 髖部骨折定義 4
第三節 髖部骨折發生率、死亡率及相關醫療費用 5
第四節 手術植入物 7
第五節 巴氏量表(Barthel Index) 9
第六節 醫療費用 10
第三章 研究方法 12
第一節 研究範圍 12
第二節 研究設計與架構 12
第三節 研究假說 13
第四節 資料處理與統計方法 14
第四章 研究結果 16
第一節 病歷資料分析:描述性統計 16
第二節 兩種不同髖骨骨折型態病患之組間差異 17
第三節 影響不同醫療資源耗用因素的迴歸分析 20
第四節 對病患存活的情形的組間差異 26
第四章 討論 29
第五章 結論與建議 34
第一節 結論 34
第二節 限制與建議 34
第三節 未來與展望 35
參考文獻 36
中文文獻 36
Reference 38
附錄A IRB審定書 43
附錄B IRB研究問卷 44
附錄C 巴氏量表 63
中文文獻:
1. 李奇學,1995,病人疾病嚴重程度與醫療資源耗用,醫療費用之相關研究-以某區域教學醫院加護病房為例,中國醫藥學院,碩士論文。
2. 吳肖琪,林麗嬋,藍忠孚,吳義勇,1998,“全民健保實施後急性病床住院病患超長住院情形之分析”,中華公共衛生雜誌,17卷,2期,頁139~147。
3. 祝道松,2004,“醫院實施臨床路徑對住院日數、醫療費用及醫療照護品質影響之研究-以人工髖關節置換手術為例”,健康管理學刊,2卷,1期,頁21~36。
4. 洪維河,1990,病人住院日數與住院費用的關係-以DRG155為例,國立台灣大學,碩士論文。
5. 施麗媛,2005,“老年骨折與處理”,老年醫學會期刊,51期。
6. 梁忠詔,2001,影響復健科患者住院天數長短因素之探討-以花東某醫學中心為例,國立東華大學,碩士論文。
7. 陳瑛瑛,2004,加護病房院內感染與抗藥性微生物之盛行率及其對住院天數和醫療成本之影響探討,國立陽明大學,博士論文。
8. 陳九五,黃明賢,蔡瑞熊,1994,“影響老人住院日數因素之初探”,The Kaohsiung Journal of Medical Sciences,10卷,12期,頁675~682。
9. 莊逸洲,黃崇哲,鄭明智,2003,“台灣醫院總額支付制度運作模式的初步探討”,醫務管理期刊,4卷,3期,頁1~16。
10. 黃公怡,王福權,1984,“鵝頭釘治療股骨轉子間骨折的療效分析”,中華骨科雜誌,4期,頁349~353。
11. 葉致昌,2005,“骨質疏鬆性骨折的手術治療”,嘉榮醫訊,89期。
12. 董正玫,1997,臨床路徑對醫療成本與住院天數之影響-以某區域醫院之闌尾切除術為例,國立陽明大學,碩士論文。
13. 蔡素女,1991,住院日控制制度對住院日數影響之研究,國立台灣大學,碩士論文。
14. 魯英,羅先正,1991,“例股骨粗隆間骨折治療分析”,骨與關節損傷雜誌,17卷,9期。
15. 鄭國棟,1991,住院日數影響因素之探討-以某醫學中心十種常見疾病為例,高雄醫學院,碩士論文。
16. 鄭錦翔,2004,臨床路徑應用於人工膝關節置換術之成效評估,國立中山大學,碩士論文。
17. 盧世璧,王繼芳,朱盛修等,1987,“加壓滑動鵝頭釘治療股骨粗隆間骨折”,中華外科雜誌,頁63~78。
18. 謝智新,2005,“老人的致命傷-髖部骨折”,高醫醫訊月刊,25卷,7期。
19. 簡麗年,朱慧凡,劉見祥,鐘國彪,曹昭懿,吳義勇,吳肖琪,2003,“醫院、醫師手術量與醫療品質之相關性探討─以全股(髖)關節置換為例”,台灣衛誌,22卷,2期,頁118~126。
20. 魏敏雄,2005,手術量與醫療品質及利用之相關性探討—以全膝關節置換術為例,高雄醫學大學,碩士論文。
21. 羅健銘,2004,住院癌末病患照護型態對住院醫療費用與住院天數之影響,國立台北護理學院,碩士論文。
22. 蘇俊霖,2003,以案例式推理建構出院準備服務後續照護資訊系統,國立雲林科技大學,碩士論文。
Reference:
1. Millar WJ, Hill GB. Hip fracture: mortality, morbidity and surgical treatment. Health Rep 1994;6: 323-7.
2. Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17:505S-11S.
3. Phadungkiat S, Chiengthong K, Charialertsak S. A study on the incidence of hip fracture in ChiangMai. J Med Assoc Thai 2002;85:565-71.
4. Gullberg B, Johnell O, Kanis JA. World-wide projection for hip fracture. Osteoporosis Int 1997;7:407-13.
5. Lauderdale DS, Jacobsen SJ, Furner SE. Hip fracture incidence among eladerly Asain-American populations. Am J Epidemiol 1997;146:502-9.
6. Lau EM, Cooper C. The epidemiology of osteoporosis: the oriental perspective in a world context. Clin Orthop 1996;323:65-74.
7. Lau EM, Suriyawongpaisal P, Saw SM. The incidence of hip fracture in four Asian countries: Asian Osteoporosis Study (AOS). Osteoporos Int 2001;12:239-43.
8. Hoffenberg R, James OFW, Brocklehurst JC, Green ID, Honoche P, Kanis JA, et al. Fractured neck of
femur: prevention and management. J R Coll Physicians Lond 1989;23:8–12.
9. Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet 1985;1:150-1.
10. Falch JA, Kaastad TS, Bohler G, Espeland J, Sundsvold OJ. Secular increase and geographical differences in hip fracture incidence in Norway. Bone 1993;14:643–5.
11. Johnell O, Nilsson B, Obrant R. Age and sex patterns of hip fracture changes in 30 years. Acta Orthop Scand 1984;55:290–2.
12. Gullberg B, Duppe H, Nilsson B, Redlund-Johnell I, Sernbo I, Obrant K. Incidence of hip fractures in Malmo, Sweden (1950–1991). Bone 1993; 14(Suppl): s23-9.
13. Zetterberg C, Elmersom S, Andersson G. Epidemiology of hip fractures in Goteborg, Sweden. Clin Orthop 1984;191:43–52.
14. Nilsson R, Lofman O, Berglund K. Increased hip fracture incidence in the county Ostergotland, Sweden, 1940–1986 with forecasts up to the year 2000. An epidemiologic study. Int J Epidemiol 1991;20:1018–24.
15. Rockwood PR, Horne JG, Cryer C. Hip fractures: a future epidemic? J Orthop Trauma 1990;4:388–93.
16. Rodriguez JG, Sattin R, Waxweiler R. Incidence of hip fractures, United States 1970–1983. Am J Prev Med 1989;5:175–81.
17. Martin AD, Silverthorn KG, Houston CS, Bernhardson S, Wajda A, Roos L. The incidence of fractures in the proximal femur in two million Canadians from 1972 to 1984. Clin Orthop 1991;266:111–8.
18. Melton LJ III, O’Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures. Calcif Tissue Int 1987;41:57–64.
19. Ray W, Griffin M, West R. Incidence of hip fracture in Saskatchewan, Canada. Am J Epidemiol 1990;131:502–9.
20. Dretakis EK, Giaourakis G, Steriopoulos K. Increasing incidence of hip fracture in Crete. Acta Orthop Scand 1992;63:150–1.
21. Lizaur-Utrilla A, Puchades-Orts A, Sanchez-del-Campo F, Anta-Barrio J, Guttierez-Carbonell P. Epidemiology of trochanteric fractures of the femur in Alicante, Spain, 1974–1982. Clin Orthop 1987;218: 24–31.
22. Hedlund R, Lindgren U, Ahlbom A. Age- and sex- specific incidence of femoral neck and trochanteric fractures: an analysis based on 20 538 fractures in Stockholm County, Sweden, 1972–1981. Clin Orthop 1987;222:132–9.
23. Lord SR. Hip fractures: changing patterns in hospital bed use in NSW between 1979 and 1990. Aus NZ J Surg 1993;352–5.
24. Parkkari J, Kannus P, Niemi S, Pasane M, Jarvinen M, Luthje P, Vuori I. Increasing age-adjusted incidence of hip fractures in Finland: the number and incidence of fractures in 1970–1991 and prediction for the future. Calcif Tissue Int 1994;55:342–5.
25. Cooper C, Campion C, Melton LJ III. Hip fractures in the elderly:world wide projections. Osteoporos Int 1992;2:285–9.
26. Lua EM, Cooper C, Wickham C. Hip fracture in Hong Kong and Britain. Int J Epidemiol 1990;19:1119-21.
27. Johnell O. The socioeconomic burden of fractures: today and in the 21st century. Am J Med 1997; 103(2A):20S-5S.
28. Suriyawongpaisal P, Siriwongpairat P, Laohacharoensombat W. A multicenter study on hip fractures in Thailand. J Med Assoc Thai 1994;17: 489-95.
29. Haentjens P, Autier P, Barette M, Boonen S. Costs of care after hospital discharge among women with a femoral neck fracture. Clin Orthop 2003;414: 250-8.
30. Haentjens P, Autier P, Barette M, Boonen S. The economic cost of hip fractures among elderly women: A one-year prospective observational cohort study with mathed-pair analysis. J Bone Joint Surg[Am] 2001;83:493-500.
31. Rogmark C, Carlsson A, Johnell O, Sernbe I. Costs of internal fixation and arthropasty for displaced femoral neck fractures. A randomized study of 68 patients. Acta Orthop Scand 2003;74:293-8.
32. Brainsky A, Glick H, Lydick E. The economic cost of hip fractures In community-dewelling older adults: A prospective study. J Am Geriat Soc 1997;45:281-7.
33. French FH, Torgerson DJ, Porter RW. Cost analysis of fracture of the neck of femur. Age Ageing 1995;24:185-9.
34. Hollingworth W, Todd C, Parker M, Roberts J, Williams R. Cost analysis of early discharge after hip fracture. BMJ 1993;307:903-6.
35. Lawrence TM, White CT, Wenn R, Moran CG. The current hospital costs of treating hip fractures. Int J Care Injured 2005;36:88-91.
36. Autier P, Heantjens P, Bentin J. Costs induced by hip fractures: A prospective controlled study in Belgium. Osteoporos Int 2000;11:373-80.
37. Reginster JY, Gillet P, Sedrine WB. Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 1999;15:507-14.
38. Morales-Toerres J, Gutierrez-Urena S. The burden of osteoporosis in Latin America. Osteoporosis Int 2004;15:625-32.
39. Southeast Asia: Thailand : Economy [NationMaster website]. Available at http://www.nationmaster.com/country/th/economy. Accessed June 25, 2005.
40. Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 2000;191:123-30.
41. Schurch MA, Rizzoli R, Mermillod B, Vasey M. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 1996;11:1935-42.
42. Wong MK, Arjandas, Ching LK, Lin SL, Lo NN. Osteoporotic hip fracture in Singapore-costs and patient’s outcome. Ann Acad Med Singapore 2002;31:3-7.
43. K. M. Fox, S. R. Cummings, E. Williams, K. Stone et al. Femoral Neck and Intertrochanteric Fractures Have Different Risk Factors: A Prospective Study. Osteoporosis International 2000;11(12):1018-1023.
44. Koval K. J., Aharonoff G. B., Rokito A. S., Lyon T., Zuckerman J. D.. Patients with femoral neck and intertrochanteric fractures: Are they the same? Clinical orthopaedics and related research 1996;330:166-172.
45. Haentjens P. Autier P. Barette M. Venken K. Vanderschueren D. Boonen S. Hip Fracture Study Group. Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone. 2007;41(6):958-64.
46. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290?. )
47. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733-6.
48. Barrett-Connor E. The economic and human costs of osteoporotic fracture. American Journal of Medicine 1995;98(suppl 2A):2A–3S to 2A–8S.
49. Lawrence TM, White CT, Wenn R, Moran CG. The current hospital costs of treating hip fractures. Injury 2005; 36:88-91.
50. Wong MK, Arjandas, Ching LK, Lim SL, Lo NN. Osteoporotic hip fractures in Singapore – costs and patient’s outcome. Ann Acad Med Singapore 2002; 31:3-7.
51. Reginster JY, Gillet P, Sedrine WB, et al. Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmocoeconomics 1999; 15:507-14.
52. Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 1993; 3:148-53.
53. Zethraeus N, Stromberg L, Jonsson B, Svensson 0, Ohlen G. The cost of a hip fracture. Acta Orthop Scand 1997; 68:13-7.
54. Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 2001; 12:271-8.
55. Autier P, Haentjens P, Bentin J, et al. Cost induced by hip fractures: a prospective controlled study in Belgium. Osteoporos Int 2000; 11:373-80.
56. Haentjens P, Autier P, Barette M, Boonen S. The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. J Bone Joint Surg Am 2001; 83-A: 493-500.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top