跳到主要內容

臺灣博碩士論文加值系統

(44.201.99.222) 您好!臺灣時間:2022/12/04 00:16
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

: 
twitterline
研究生:林佩珍
研究生(外文):LIN, PEI-JAN
論文名稱:臺灣全身性紅斑狼瘡患者門、急診醫療費用分析
論文名稱(外文):Analysis of Medical Expenses for Patients with Systemic Lupus Erythematosus in Taiwan
指導教授:洪錦墩洪錦墩引用關係
指導教授(外文):HUNG, CHIN-TUN
口試委員:李淑芬黃光華
口試委員(外文):LI, SHU-FENHUANG, KUANG-HUA
口試日期:2017-06-12
學位類別:碩士
校院名稱:中臺科技大學
系所名稱:醫療暨健康產業管理系碩士班
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:2017
畢業學年度:105
語文別:中文
論文頁數:70
中文關鍵詞:紅斑狼瘡醫療利用健保資料庫
外文關鍵詞:lupus erythematosusmedical usehealth care database
相關次數:
  • 被引用被引用:0
  • 點閱點閱:162
  • 評分評分:
  • 下載下載:14
  • 收藏至我的研究室書目清單書目收藏:0
全身性紅斑狼瘡被臺灣全民健康保險列為重大傷病之一。其中以亞洲女性的發生率最高,據統計在亞洲每10萬人中有3至6人罹患此疾病。由於其屬於免疫性疾病,常併發其他疾病因而衍生健康問題及醫療費用而受到關注。本研究之目的在探討全身性紅斑狼瘡患者在門診、急診醫療利用與費用之現況及其影響因素。
本研究以國家衛生研究院2000年版全民健康保險學術研究資料庫提供的百萬抽樣歸人檔為資料來源,擷取2010年內初確診為全身性紅斑狼瘡患者為研究對象,並用傾向分數配對法對紅斑狼瘡患者之年齡與性別進行1:4之比率,擷取非全身性紅斑狼瘡患者為對照組確診全身性紅斑狼瘡患者有1,130人,其中男性為143人,女性為987人(約87.3%),另對照組為無全身性紅斑狼瘡者計有4,520人。
  研究結果顯示全身性紅斑狼瘡患者於門、急診醫療利用與費用分別為15.92次、0.36次與34,954元、1,710.12元顯著高於無全身性紅斑狼瘡者的7.50次、0.13次與7,204.76元、343.35元。全身性紅斑狼瘡患者在門急診醫療利用次數於性別並無統計顯著差異,但於年齡小於17歲則門診次數及醫療費用有愈高之趨勢,急診則以年齡大於65歲的急診次數及費用有愈高之趨勢。以迴歸模型分析全身性紅斑狼瘡者若合併高血壓、糖尿病、腦中風、心衰竭四種疾病患者在門診次數、門診費用、急診次數、急診費用有愈高之趨勢。因此於全身性紅斑狼瘡患者若能控制其他共病症發生有助其減少醫療利用與醫療費用。

Systemic lupus erythematosus is classified as one of the major injuries by Taiwan's universal health insurance. Women have the highest incidence in Asia. According to statistics in Asia, 3 to 6 out of every 100,000 people suffer from this disease. Since it is an autoimmune disease, often accompanied by other diseases and thus derived health problems and medical expenses. The purpose of this study is to investigate the current situation and influencing factors of outpatient and emergency medical use as well as expenditure by patients with systemic lupus erythematosus.
The research database is from the National Health Insurance academic research data and we capture the patients diagnosed as systemic lupus erythematosus in 2010 as the research object. In addition, we use propensity score matching method in the ratio of patients with lupus erythematosus and Non - systemic lupus erythematosus patients was 1: 4. There were 1,130 people diagnosed with systemic lupus erythematosus, including 143 males and 987 females (about 87.3%). The control group had 4,520 patients without systemic lupus erythematosus.
  The results appears that systemic lupus erythematosus patients in the outpatient medical use, emergency medical use and both medical expenditure are 15.92 times, 0.36 times, NTD 34,954 and NTD 1,710.12, respectively. In addition, the patients without systemic lupus erythematosus are 7.50 times, 0.13 times, NTD 7,204.76 and NTD 343.35. It shows that the outpatient medical use, emergency medical use and both medical expenditure systemic lupus erythematosus patients are higher than those without systemic lupus erythematosus. There was no statistically significant difference in the gender of patients with systemic lupus erythematosus. However, at the age of less than 17 years old, the higher the number of outpatient and medical expenses, the higher the number of emergencies and costs of older than 65 years. Finally, the patients with systemic lupus erythematosus accompanied by hypertension, diabetes, stroke, heart failure whose outpatient visits, outpatient costs, emergency times and emergency costs are higher than those without four diseases. Thus patients with systemic lupus erythematosus should avoid comorbidity to reduce their medical use and medical expenses.

中文摘要 I
英文摘要 II
目錄 III
表目錄 IV
圖目錄 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 全身性紅斑狼瘡病徵 4
第二節 全身性紅斑狼瘡的流行病學研究分析 14
第三節 全身性紅斑狼瘡之醫療費用相關研究 16
第三章 研究方法 22
第一節 研究架構 22
第二節 研究假設 23
第三節 研究設計 24
第四節 資料來源 25
第五節 研究對象 26
第六節 資料分析 27
第七節 研究流程 28
第八節 研究變項與操作型定義 29
第四章 研究結果與討論 31
第一節 研究對象基本特性 31
第二節 全身性紅斑狼瘡與否之醫療利用比較 33
第三節 全身性紅斑狼瘡醫療費用影響相關因素分析 44
第四節 研究結果小結 51
第五節 研究限制 52
第五章 結論與建議 53
第一節 結論 53
第二節 建議 54
參考文獻 55
中文文獻 55
英文文獻 57

中文文獻
何慧蓉(2015)。台灣初診斷多發性硬化症患者就醫行為探討(碩士論文)。取自http://handle.ncl.edu.tw/11296/ndltd/12069629409890464867
沈希哲、胡鎮如、李中一、柯明中、陳楚杰(2015)。台灣地區兒童急診醫療利用及其相關因素之研究。台灣公共衛生雜誌,34(1),50-60。doi:10.6288/TJPH201534103108
沈佑銓(2016).神經精神系統紅斑狼瘡的侵犯. 社團法人中華民國風濕病醫學會.取自http://www.rheumatology.org.tw/health/health_info.asp?/248.html
金沁琳(2006)。台灣全身性紅斑狼瘡患者罹病率、共病、醫療利用與費用及其生活品質之研究(碩士)。取自http://ezproxy.ctust.edu.tw:2100/11296/ndltd/90733723100170484629
吳昭儀、潘璦琬(2015)。紅斑性狼瘡個案生活品質相關因素之系統性文獻回顧。職能治療學會雜誌,33(2),168-186。 doi:10.6594/JTOTA.2015.33(2).03
吳美玲、吳佳玲(2014)。一位初診斷全身性紅斑性狼癐女性的身體經驗。領導護理,15(4),60-70。
李佩倫、王蔚芸(2014)。一位紅斑性狼瘡併腎病症候群病人之護理經驗。腎臟與透析,26(1),53-62。doi:10.6340/KD.2014(1).10
李佩諭(2014)。運用關聯規則探討全身性紅斑狼瘡患者確診前之門診醫療利用模式:使用全民健保資料庫(碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/61688490344589662485
李曉伶、吳肖琪(2013)。台灣慢性病人醫療利用之探討-以慢性腎臟病、糖尿病及高血壓為例。台灣公共衛生雜誌,32(3),231-239。doi:10.6288/TJPH2013-32-03-03
宋文娟、洪錦墩、陳文意(2008)。台灣老年人口醫療利用與多重慢性疾病之分析研究。臺灣老人保健學刊,4(2),75-87。
林孝義、陳玉萍、葉純宜(2014)。全身性紅斑狼瘡病人治療及護理新趨勢。榮總護理,31(2),121-128。doi:10.6142/VGHN.31.2.121
林佟威(2016)。兒童風濕疾病對於病人罹癌風險及其罹癌前醫療利用之探討(碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/34553603755310495452 林敬家(2011)。以全民健保承保抽樣歸人檔分析慢性鼻竇炎的醫療利用(碩士論文)。取自華藝線上圖書館系統。(系統編號U0005- 1207201119342700)
徐均宏、白瑞聰、王晴祺(2010).台灣地區紅斑性狼瘡的流行病學分析研究 .2016年 10 月取自http://ir.lib.ypu.edu.tw/handle/310904600Q/5879
陳基益(2013)。免疫生物製劑治療自體免疫疾病之現在與未來:以紅斑性狼瘡為典範。台灣醫學,17(1),41-48。doi:10.6320/FJM.2013.17(1).08
陳俞蓉、王素琴、莊雪芳、白美娟(2015)。一位年輕女性狼瘡腎炎初次血液透析之護理經驗。臺灣腎臟護理學會雜誌,14(2),47-60。doi:10.3966/172674042015061402005
陳瑋昇、林孝義、黃德豐(2009).全 身性紅斑性狼瘡腎炎治療的新進 展. 內科學誌, 20 (1),40-47。
張于慧、黃朱貝、黃慧雯、陳玉萍、林柏瑤、白玉珠(2014)。系統性紅斑性狼瘡病人運動照護指引之建立。榮總護理,31(2),165-175。doi:10.6142/VGHN.31.2.165
張峰玉、蘇麗智、王曼蒂(2014)。全身性紅斑性狼瘡病人服藥遵從性及其影響因素之探討。護理暨健康照護研究,10(1),33-41。doi:10.6225/JNHR.10.1.33
張佑任(2014)。重症紅斑性狼瘡病人血清IgG與ESR對其預後之關連性研究(碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/52728035236772773135
黃見成、白瑞聰、徐均宏、王晴祺(2012)。全身性紅斑狼瘡患者使用奎寧發生末期腎病/惡性腫瘤/中風/骨質疏鬆之相關性研究。健康管理學刊,10(2),178-188。
葉馨智(2014)。以台灣全民健保資料庫分析紅斑狼瘡病人之存活與結果 (碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/66485719964960852705
賴宏睿(2014)。紅斑性狼瘡患者確診前後一年之醫療利用與預後(碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/34757793314270680464
鄭怡婷(2016)。兒童及成人系統性紅斑性狼瘡患者罹患末期腎臟疾病風險及其醫療利用之探討(碩士論文)。 取自http://handle.ncl.edu.tw/11296/ndltd/53040386784983333128
英文文獻
.Avina-Zubieta, J. A., To, F., Vostretsova, K., De Vera, M., Sayre, E. C. and Esdaile, J. M. (2016), Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care & Research. Accepted Author Manuscript. doi:10.1002/acr.23018
.A P Anandarajah, M Luc, C TRitchlin (2016).Hospitalization of patients with
systemic lupus erythematosus is a major cause of direct and indirect healthcare costs,Lupus,12. Doi: 10.1177/0961203316676641
.Alamoudi, O. S., & Attar, S. M. (2015). Pulmonary manifestations in systemic lupus erythematosus: Association with disease activity. Respirology (Carlton, Vic.), 20(3), 474–480. Doi:org/10.1111/resp.12473
.Arnaud L ,Fagot JP ,Mathian A,Paita M ,Fagot-Campagna A,Amoura
Z(2014).Prevalence and incidence of systemic lupus erythematosus in France: A 2010 nation-wide population-based study.Autoimmunity Reviews, 13(11), 1082-1089. Doi: 10.1016/j.autrev.2014.08.034. Epub 2014 Aug 27.
.A Jonsen, A A Bengtsson, F Hjalte, I F Petersson, M Willim, O Nived (2015). Total cost and cost predictors in systemic lupus erythematosus – 8-years follow-up of a Swedish inception cohort. Lupus ,24(12), 1248 – 1256. Doi:10.1177/0961203315584812
.Andrzej Sliwczyński, Melania Brzozowska, Petre Iltchev, Tomasz Czeleko, Zbigniew Teter,Witold Tłustochowicz, Michał Marczak, Małgorzata Tłustochowicz ( 2015). Changes in the morbidity and costs of systemic lupus erythematosus in Poland in the years 2008–2012.Reumatologia,53( 2), 79–86. DOI:10.5114/reum.2015.51507
.Arnaud, L., Fagot, J. P., Mathian, A., Paita, M., Fagot-Campagna, A., & Amoura, Z. (2014). Prevalence and incidence of systemic lupus erythematosus in France: a 2010 nation-wide population-based study. Autoimmunity reviews, 13(11), 1082-1089.
.Andreas Jönsen, Anders A. Bengtsson (2013). Direct and Indirect Costs For Patients With Systemic Lupus Erythematosus In National Cohorts In Sweden. AMERICAN COLLEGE OF RHEUMATOLOGY, 2013 ACR/ARHP Annual Meeting.Epidemiology and Health Services Research III: Healthcare Costs and Mortality in Rheumatic Disease. in San Diego, CA.
.Chiu,YM,Chuang,MT&Lang,HC (2016). Medical costs incurred by organ damage caused by active disease, comorbidities and side effect of treat ments in systemic lupus erythematosus patients: a Taiwan nationwide popu lation-based study.Rheumatol Int, 36(11),1507-1514. doi:10.1007 / s00296-016-3551- y
.Chang, Y. S., Liu, C. J., Wu, T. H., Chaou, C. H., Lin, K. C., Ou, S. M., ... & Tsai, C. Y. (2012). Survival analysis in systemic lupus erythematosus patients on maintenance dialysis: a nationwide population-based study in Taiwan. Rheumatology, kes325.
.Clarke A, Urowitz M, Monga N, et al(2013).AB1311 Healthcare costs of systemic lupus erythematosus (SLE) patients in canada: The impact of disease severity and flares. Annals of the Rheumatic Diseases,71(3),712. doi.org/10.1136/annrheumdis-2012-eular.1307
.Doria, A., Amoura, Z., Cervera, R., Khamastha, M. A., Schneider, M., Richter, J., ... & Perna, A. (2014). Annual direct medical cost of active systemic lupus erythematosus in five European countries. Annals of the rheumatic diseases, 73(1), 154-160.
.Dafna D Gladman (2015).Overview of the clinical manifestations of systemic lupus erythematosus in adults. Retrieved from http://www.uptodate.com
.Furst, D. E., Clarke, A., Fernandes, A. W., Bancroft, T., Gajria, K., Greth, W., & Iorga, S. R. (2013). Resource utilization and direct medical costs in adult systemic lupus erythematosus patients from a commercially insured population. Lupus, 22(3), 268-278.
.Garris, C., Shah, M., & Farrelly, E. (2015). The prevalence and burden of system ic lupus erythematosus in a medicare population: retrospective analysis of
medicare claims. Cost Effectiveness and Resource Allocation, 13(1), 9.
.Han, G. M., & Han, X. F. (2017). Comorbid Conditions are Associated With Emergency Department Visits, Hospitalizations, and Medical Charges of Patients With Systemic Lupus Erythematosus. JCR: Journal of Clinical Rheumatology, 23(1), 19-25.
.Ju, J. H., Yoon, S.-H., Kang, K. Y., Kim, I. J., Kwok, S.-K., Park, S.-H., … Cho, C.-S. (2014). Prevalence of Systemic Lupus Erythematosus in South Korea: An Administrative Database Study. Journal of Epidemiology, 24(4), 295–303. http://doi.org/10.2188/jea.JE20120204
.Lerang, K., Gilboe, I. M., Steinar Thelle, D., & Gran, J. T. (2014). Mortality and years of potential life loss in systemic lupus erythematosus: a population-based cohort study. Lupus, 23(14), 1546-1552.
.Lin, W. H., Guo, C. Y., Wang, W. M., Yang, D. C., Kuo, T. H., Liu, M. F., &
Wang, M. C. (2013). Incidence of progression from newly diagnosed systemic lupus erythematosus to end stage renal disease and all-cause mortality: A nationwide cohort study in Taiwan. International Journal of Rheumatic Diseases. 16 (6):747-753. doi: 10.1111/1756-185X.12208
.Lu, C. C., Lai, J. H., Chen, C. H., Lee, T. S. H., Tsai, C. S., Kuo, S. Y., & Chang, D. M. (2011). Cardiac surgery in patients with systemic lupus erythematosus: a medical center's experience in Taiwan. Formosan Journal of Rheumatology.69-78.
.Livingston, B., Bonner, A., & Pope, J. (2011). Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta- analysis. Lupus. 20(13): 1345-1355.
.Tektonidou, M. G., Wang, Z., Dasgupta, A., & Ward, M. M. (2015). Burden of Serious Infections in Adults With Systemic Lupus Erythematosus: A National Population‐Based Study, 1996–2011. Arthritis care & research, 67(8), 1078-1085.
.Tseng, Y. C., Wu, C. H., & Yu, C. L. (2012). Reality and Recommendation:Comparison between Current Practice Patterns in a Single Center in Taiwan and the ACR 2010 Recommendations for Glucocorticoid-induced Osteoporosis Treatment among Elderly Patients with Systemic lupus Erythematosus, Polymyositis, and Dermatomyositis. Formosan Journal of Rheumatology, 26(1&2), 100-108.
.Salehi-Abari, I. (2015). ACR/SLICC Revised Criteria for Diagnosis of Systemic Lupus Erythematosus. Autoimmune Dis Ther Approaches Open Access. 2(1): 114.
.Śliwczyński, A., Brzozowska, M., & Illitchev, P. (2015). Changes in the morbidity and costs of systemic lupus erythematosus in Poland in the years 2008– 2012. Reumatologia, 53(2), 79-86.
.Somers, E. C., Marder, W., Cagnoli, P., Lewis, E. E., DeGuire, P., Gordon, C., ...& Leisen, J. (2014). Population‐Based Incidence and Prevalence of Systemic Lupus Erythematosus: The Michigan Lupus Epidemiology and Surveillance Program. Arthritis & Rheumatology, 66(2), 369-378.
.Shim, J. S., Sung, Y. K., Joo, Y. B., Lee, H. S., & Bae, S. C. (2014). Prevalence and incidence of systemic lupus erythematosus in South Korea. Rheumatology international, 34(7), 909-917.
.Stohl, W., Hiepe, F., Latinis, K. M., Thomas, M., Scheinberg, M. A., Clarke, A., ... & Pineda, L. (2012). Belimumab reduces autoantibodies, normalizes low complement levels, and reduces select B cell populations in patients with systemic lupus erythematosus. Arthritis & Rheumatism, 64(7), 2328-2337.
.Slawsky, K. A., Fernandes, A. W., Fusfeld, L., Manzi, S., & Goss, T. F. (2011). A structured literature review of the direct costs of adult systemic lupus erythematosus in the US. Arthritis care & research, 63(9), 1224-1232.
.Popescu, A., & H Kao, A. (2011). Neuropsychiatric systemic lupus erythematosus. Current neuropharmacology, 9(3), 449-457.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top