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研究生:石良盛
研究生(外文):Liang-Sheng Shih
論文名稱:月經異常對患者於醫療資源利用之影響
論文名稱(外文):The Effect of Patients with Menstrual Disorders on Medical Care 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:企業管理學系醫務管理碩士班
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:2016
畢業學年度:105
語文別:中文
論文頁數:65
中文關鍵詞:全民健康保險研究資料庫傾向分數配對醫療資源月經月經異常
外文關鍵詞:health care resourceMenstruationmenstrual disorderNational Health Insurance Research DatabasePropensity Score Matching
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目的:
本研究以女性月經異常患者之醫療照護情形為研究重點,探討月經異常對女性患者醫療資源利用情形之影響。
方法:
本研究使用國家衛生研究院所提供之全民健康保險研究資料庫,為次級資料分析之回溯性研究,根據ICD-9-CM診斷碼篩選月經異常患者,並排除研究期間有懷孕紀錄者作為研究個案組,對照組則採用傾向分數配對法,控制年齡與共病症權重指數以1:3的比例產生之無月經異常患者。研究期間為2010年至2012年,觀察起始日為於2010年初次因月經異常或初次因任何原因門診就醫,共追蹤兩年。以描述性統計、卡方檢定、t檢定、線性複迴歸與邏輯斯迴歸等統計方法進行分析,探討兩組別於醫療資源利用情形間之差異。
結果:
研究結果顯示,月經異常的分布以18-29歲佔多數。經線性複迴歸分析,有月經異常之女性患者在門診、急診與住院的次數皆高於無月經異常之女性患者,門急診總費用也以有月經異常之女性為多,且皆達到統計上的顯著差異(p<0.05);邏輯斯迴歸分析結果為有月經異常之女性患者急診風險值為1.32 (95%CI 1.26-1.39);住院的風險值為1.68 (95%CI 1.55-1.82),皆顯著高於對照組(p<0.01)。
結論:
本研究結果顯示,有月經異常的女性患者確實有較高的醫療資源使用,其發生急診與住院的風險也較高。因此,政府與國民皆應重視月經異常所造成的負面影響,以促進女性健康福祉的提升,並達到降低資源浪費與提升照護品質之目的。
Objective:
The main objective of this study was focusing on female patients with menstrual disorders, and assessed the effect on medical care resource utilizations.
Method:
This research adopted a retrospective cohort study. Subjects were identified using National Health Insurance Research Database in Taiwan. We formed a new cohort of female patients with menstrual disorders and excluded the subjects with pregnancy as the case group. The female patients without menstrual disorders and pregnancy were the control group. Propensity Score Matching (PSM) was used to control the age and Charlson Comorbidity Index (CCI) for reducing sample selection bias. The following period was 2010 through 2012. The starting date was the first outpatient visit for menstrual disorder or any other reason in 2010, and following 2 years. Furthermore, t-test, chi-square test and regression analysis were used to assess medical care resource utilizations between the two groups.
Results:
The results showed that characteristic of patients with menstrual disorders were younger. The utilization of outpatient, emergency and hospitalization on patients with menstrual disorders were significantly higher (p<0.05). Furthermore, the risk of emergency visit in the case group was significantly higher than the control group (OR 1.32; 95%CI 1.26 to 1.39). The risk of hospitalization event was also higher in the case group (OR 1.68; 95%CI 1.55 to 1.82).
Conclusion:
The results of the study demonstrate that patients suffering from menstrual disorders significantly increased the utilization of health care resources, and the risk of emergency visit and hospitalization were higher in the patients with menstrual disorders.
論文審定書 i
謝辭 ii
摘要 iii
Abstract iv
目錄 v
圖次 vii
表次 vii
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 月經異常之介紹 4
第二節 月經異常之負面影響 7
第三節 月經異常於醫療照護之影響 8
第三章 研究方法 10
第一節 研究設計與架構 10
第二節 研究問題與研究假設 12
第三節 研究樣本與資料來源 13
第四節 研究變項之操作型定義 16
第五節 研究分析工具及方法 18
第四章 研究結果與分析 19
第一節 研究樣本人口學特質資料與就醫之醫療機構特性分布 19
第二節 人口學特質於研究組別之醫療資源利用情形 25
第三節 醫療機構特性於兩組研究樣本間對醫療資源利用情形之檢定分析 27
第四節 各變項對醫療資源利用所產生的影響之檢定分析 31
第五章 討論 43
第一節 月經異常的分布情形 43
第二節 月經異常的醫療資源利用情形 44
第三節 月經異常的急診與住院風險 45
第四節 研究假設驗證 46
第六章 結論與建議 47
第一節 結論 47
第二節 研究限制 48
第三節 研究建議 49
第四節 研究貢獻 50
參考文獻 51
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